Active NPI
San Juan County Fire Protection District 4
- Land Ambulance
- Lopez Island, WA
National Provider Identifier
1649398405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- License
- 28D04
- Legal business name
- SAN JUAN COUNTY FIRE PROTECTION DISTRICT 4
- Practice address
- 2228 Fisherman Bay Rd
Lopez Island, WA 98261-8676 - Phone
- (360) 468-2991
- Fax
- (360) 468-3716
- NPI assigned
- Mar 27, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. James P. Ghiglione
- Title
- Fire Chief
- Phone
- (360) 468-2991
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 28D04 | WA | Primary |
Addresses
Primary practice location
2228 Fisherman Bay Rd
Lopez Island, WA 98261-8676
Mailing address
2228 Fisherman Bay Rd
Lopez Island, WA 98261-8676
Phone (360) 468-2991
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 28D04 | Other | WA | EMS LICENSE |
| 9046061 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070615000342 | WA | Part B Supplier - Ambulance Service Supplier | 4880793801 | Practice locations: Lopez Island, WA |
National Provider Directory
National Provider Directory- Tax ID family
- San Juan County Fire Protection District 4
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Ambulance
- Lopez Island, WA
- NPI 1265634323
Locations
4136 Center Rd
Lopez Island, WA 98261
Phone (360) 468-2991
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1358899200000",
"number": "1649398405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2228 FISHERMAN BAY RD",
"city": "LOPEZ ISLAND",
"state": "WA",
"postal_code": "982618676",
"telephone_number": "360-468-2991",
"fax_number": "360-468-3716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2228 FISHERMAN BAY RD",
"city": "LOPEZ ISLAND",
"state": "WA",
"postal_code": "982618676",
"telephone_number": "360-468-2991",
"fax_number": "360-468-3716"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAN JUAN COUNTY FIRE PROTECTION DISTRICT 4",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-27",
"last_updated": "2013-01-23",
"status": "A",
"authorized_official_last_name": "GHIGLIONE",
"authorized_official_first_name": "JAMES",
"authorized_official_middle_name": "P.",
"authorized_official_title_or_position": "FIRE CHIEF",
"authorized_official_telephone_number": "360-468-2991",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "WA",
"license": "28D04",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMS LICENSE",
"identifier": "28D04",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9046061",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lopez Island, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; 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.