Provider Demographics
NPI:1366420341
Name:GRANT COUNTY FIRE DISTRICT NO
Entity type:Organization
Organization Name:GRANT COUNTY FIRE DISTRICT NO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-765-3175
Mailing Address - Street 1:4251 KIPLING STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHEATRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033
Mailing Address - Country:US
Mailing Address - Phone:303-329-9044
Mailing Address - Fax:303-336-3166
Practice Address - Street 1:11058 NELSON ROAD NE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-8812
Practice Address - Country:US
Practice Address - Phone:509-765-3175
Practice Address - Fax:509-765-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA13M18207PE0004X
WA13D05341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Not Answered341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6053257Medicaid
WA163229OtherLABOR & INDUSTRIES
WA6053257Medicaid