Provider Demographics
NPI:1053399089
Name:CITY OF PORT ANGELES
Entity type:Organization
Organization Name:CITY OF PORT ANGELES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUBUC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-417-4653
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3510
Mailing Address - Country:US
Mailing Address - Phone:360-394-7030
Mailing Address - Fax:360-394-7097
Practice Address - Street 1:102 E 5TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3014
Practice Address - Country:US
Practice Address - Phone:360-417-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA05M033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA613694000OtherOWCP
WA07093OtherLABOR & INDUSTRIES
WA590012037OtherRAILROAD MEDICARE
WA9023813Medicaid
WACI2587OtherREGENCE
WACI2587OtherREGENCE