Provider Demographics
NPI:1699886408
Name:CITY OF MUKILTEO
Entity type:Organization
Organization Name:CITY OF MUKILTEO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WETHERBEE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-263-8150
Mailing Address - Street 1:10400 47TH PL W
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275
Mailing Address - Country:US
Mailing Address - Phone:425-263-8150
Mailing Address - Fax:425-348-7606
Practice Address - Street 1:10400 47TH PL W
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275
Practice Address - Country:US
Practice Address - Phone:425-263-8150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF MUKILTEO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA31M113416L0300X
WAAMBV.ES.000006433416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9038597Medicaid
WACI4168OtherREGENCE
WA051767OtherL&I AND CRIME VICTIMS
WA590009040Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WA9038597Medicaid