Provider Demographics
NPI:1386126464
Name:WHITMAN COUNTY FIRE DISTRICT 12
Entity type:Organization
Organization Name:WHITMAN COUNTY FIRE DISTRICT 12
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MIRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STENBAKKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-334-1715
Mailing Address - Street 1:912 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2906
Mailing Address - Country:US
Mailing Address - Phone:509-334-1715
Mailing Address - Fax:509-332-2462
Practice Address - Street 1:912 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2906
Practice Address - Country:US
Practice Address - Phone:509-334-1715
Practice Address - Fax:509-332-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA38D123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA38D12OtherAMBULANCE LICENSE