Provider Demographics
NPI:1326025677
Name:WALLA WALLA COUNTY FIRE PROTECTION DISTRICT NO 5
Entity type:Organization
Organization Name:WALLA WALLA COUNTY FIRE PROTECTION DISTRICT NO 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-547-8341
Mailing Address - Street 1:460 WEST HUMORIST ROAD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:WA
Mailing Address - Zip Code:99323
Mailing Address - Country:US
Mailing Address - Phone:509-547-8341
Mailing Address - Fax:509-547-3533
Practice Address - Street 1:460 WEST HUMORIST ROAD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:WA
Practice Address - Zip Code:99323
Practice Address - Country:US
Practice Address - Phone:509-547-8341
Practice Address - Fax:509-547-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146N00000X
WA36D05341600000X
WA601138641341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA001300176Medicare ID - Type Unspecified