Provider Demographics
NPI:1134343254
Name:SNOHOMISH COUNTY FIRE DISTRICT 17
Entity type:Organization
Organization Name:SNOHOMISH COUNTY FIRE DISTRICT 17
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-691-5553
Mailing Address - Street 1:PO BOX 12383
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98082-0383
Mailing Address - Country:US
Mailing Address - Phone:360-282-3964
Mailing Address - Fax:360-282-3947
Practice Address - Street 1:116 S. GRANITE AVENUE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252
Practice Address - Country:US
Practice Address - Phone:360-691-5553
Practice Address - Fax:360-691-7837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA31D173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9061839Medicaid
G8865490Medicare UPIN