Cowlitz County Fire District 5

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

08D05 Issued in WA

Legal business name

COWLITZ COUNTY FIRE DISTRICT 5

Doing business as

Kalama Fire & Ambulance

Practice address

382 NE Frontage Rd
Kalama, WA 98625

Phone

(360) 673-2222

NPI assigned

Feb 6, 2006

Organization subpart

No

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

Authorized official

Name

Deann Sharp

Title

Administrative Secretary

Phone

(360) 673-2222

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Kalama Fire & Ambulance Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1568434348",
    "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": "360-394-7030",
            "fax_number": "360-394-7097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 NE FRONTAGE RD",
            "city": "KALAMA",
            "state": "WA",
            "postal_code": "98625",
            "telephone_number": "360-673-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COWLITZ COUNTY FIRE DISTRICT 5",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-06",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "SHARP",
        "authorized_official_first_name": "DEANN",
        "authorized_official_title_or_position": "ADMINISTRATIVE SECRETARY",
        "authorized_official_telephone_number": "360-673-2222"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WA",
            "license": "08D05",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1029744",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "590014531",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP",
            "identifier": "615281300",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I AND CRIME VICTIMS",
            "identifier": "0109943",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "KA3487",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275131",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kalama Fire & Ambulance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Justine Allen
• Gary R Armitage, LPN
• Robert Lee Blair, RN
• Mikenzie E Dixon, L.M.P.
• Jerry Ezell Jr., RN
• Michael Falter, D.M.D.
• Rochelle Grothaus, RN
• David Lawrence Hodgson, LMHCA

• Land Ambulance in Kalama, WA
• Providers in Kalama, 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 8, 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.