Snohomish County Fire District 17

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

31D17 Issued in WA

Legal business name

SNOHOMISH COUNTY FIRE DISTRICT 17

Practice address

116 S. Granite Avenue
Granite Falls, WA 98252

Phone

(360) 691-5553

Fax

(360) 691-7837

NPI assigned

Apr 12, 2007

Last updated

Jan 27, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jim Haverfield

Title

Fire Chief

Phone

(360) 691-5553

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Granite Falls Fire District 17 Other name

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264550400000",
    "number": "1134343254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12383",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980820383",
            "telephone_number": "360-282-3964",
            "fax_number": "360-282-3947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 S. GRANITE AVENUE",
            "city": "GRANITE FALLS",
            "state": "WA",
            "postal_code": "98252",
            "telephone_number": "360-691-5553",
            "fax_number": "360-691-7837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SNOHOMISH COUNTY FIRE DISTRICT 17",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2010-01-27",
        "status": "A",
        "authorized_official_last_name": "HAVERFIELD",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "360-691-5553"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WA",
            "license": "31D17",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9061839",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Granite Falls Fire District 17",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Elizabeth May Russell, SLPA
• Paul Matthew Rydberg, AEMT
• Krystal Schultz
• Gracy Shank, MA60417755
• Lauren Rene Shockley, LMP
• Snohomish County Fire District 23
• Samantha Spayd, BSN, RN
• Julie Ann Stark
• Timothy A Starsky, PHARMD
• Piper Stoulil

• Land Ambulance in Granite Falls, WA
• Providers in Granite Falls, WA by specialty
• Land Ambulance in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.