East Grays Harbor Fire and Rescue

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

14D05 Issued in WA

Legal business name

EAST GRAYS HARBOR FIRE AND RESCUE

Practice address

428 Stamper Road
Elma, WA 98541

Phone

(360) 482-6266

NPI assigned

Feb 15, 2006

Last updated

Sep 12, 2024By 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

Jody Ann Coon

Title

Administrative Assistant Chief

Phone

(360) 482-4903

Specialties & licenses 1

Addresses

Other identifiers 4

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": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1316911563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 717",
            "city": "ELMA",
            "state": "WA",
            "postal_code": "985410717",
            "telephone_number": "360-482-3143",
            "fax_number": "360-482-3152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 STAMPER ROAD",
            "city": "ELMA",
            "state": "WA",
            "postal_code": "98541",
            "telephone_number": "360-482-6266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST GRAYS HARBOR FIRE AND RESCUE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "COON",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT CHIEF",
        "authorized_official_telephone_number": "360-482-4903"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WA",
            "license": "14D05",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0143992",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9056813",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "9603GR",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS",
            "identifier": "8903696",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristi Lynn Covey, OTRL
• Zoe Daee
• Kenneth Anthony Dietrich, M.D., MBA
• Kristin Rain Dineen, LMP
• Stephen L Drasnin, MD
• Edwards & Ketcher, PLLC (Elma Family Dental)
• Karissa Ann Ellis, D.O.
• Elma Health Care Clinic, LLC
• Elma School District
• Michael S. Fisher, CRNA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; 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.