Fire Protection Dist 5 Mason County

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

23D05 Issued in WA

Legal business name

FIRE PROTECTION DIST 5 MASON COUNTY

Doing business as

Central Mason Fire & EMS

Practice address

122 W Franklin St
Shelton, WA 98584-3511

Phone

(360) 426-5533

NPI assigned

Dec 28, 2005

Organization subpart

No

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

Authorized official

Name

Timothy M McKern

Title

Fire Chief

Phone

(360) 426-5533

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Central Mason Fire & EMS Doing business as

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": "1135728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430092800000",
    "number": "1154308534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3510",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983833510",
            "telephone_number": "360-394-7010",
            "fax_number": "360-394-7099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 W FRANKLIN ST",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985843511",
            "telephone_number": "360-426-5533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRE PROTECTION DIST 5 MASON COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-28",
        "last_updated": "2015-04-27",
        "status": "A",
        "authorized_official_last_name": "MCKERN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "360-426-5533"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WA",
            "license": "23D05",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003569",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I WORKERS COMPENSATION",
            "identifier": "0016021",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590005425",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Mason Fire & EMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wilfredo Fernandez-Fonseca, LMHCA
• Rachel Field-Borodin, RN
• Fir Lane Care LLC
• Fir Lane Health - Shelton, LLC
• Fir Lane Health-Shelton,LLC
• Lux Reyes Fisher, PHD
• Raymond Flick
• Mark A. Flores, PA-C
• Ronald Flores
• Fly Free Wellness Center

• Land Ambulance in Shelton, WA
• Providers in Shelton, WA by specialty
• Land Ambulance in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; 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.