Pacific County Fire Protection District 1

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

25D01 Issued in WA

Legal business name

PACIFIC COUNTY FIRE PROTECTION DISTRICT 1

Practice address

26109 Ridge Ave
Ocean Park, WA 98640

Phone

(360) 665-4451

NPI assigned

Feb 16, 2006

Organization subpart

No

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

Authorized official

Name

Jacob Brundage

Title

Fire Chief

Phone

(360) 665-4451

Specialties & licenses 1

Addresses

Other identifiers 4

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": "1140048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350518400000",
    "number": "1699749432",
    "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": "26109 RIDGE AVE",
            "city": "OCEAN PARK",
            "state": "WA",
            "postal_code": "98640",
            "telephone_number": "360-665-4451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC COUNTY FIRE PROTECTION DISTRICT 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-16",
        "last_updated": "2012-10-18",
        "status": "A",
        "authorized_official_last_name": "BRUNDAGE",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "360-665-4451"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WA",
            "license": "25D01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9045949",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I AND CRIME VICTIMS",
            "identifier": "124426",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "299915",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "PA5887",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jerome March, DNP, FNP-BC
• April McCune, PA-C
• Kevin P McGinley, LICSW
• Nathan King Miller, D.D.S.
• Terri Miller, ARNP
• Peninsula Pharmacies Inc.
• Public Hospital District 3 of Pacific County
• Real Talk Counseling, PLLC
• Regency Long Beach LLC
• David Lester Rodriguez II, MA, LMHC

• All providers in Ocean Park, WA
• Land Ambulance in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; 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.