GRANT COUNTY FIRE DISTRICT NO — NPI 1366420341 (Board-Certified Emergency Medicine Physician (ER / Trauma Doctor) in MOSES LAKE, WA)

CMS-1500 Box 24J / 33a • NPI

1366420341

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207PE0004X (CMS 93)

Board-Certified Emergency Medicine Physician (ER / Trauma Doctor)

Box 32 Service Location & ZIP+4

11058 NELSON ROAD NE, MOSES LAKE, WA, 98837-8812

✓ 9-Digit EDI 837 ZIP+4 (98837-8812)

Practice Phone & Referral Fax

(509) 765-3175

Fax: (509) 765-3550

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1366420341 (GRANT COUNTY FIRE DISTRICT NO ) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1366420341` (NPI-2 Organization / Facility)
Provider / Legal Name	GRANT COUNTY FIRE DISTRICT NO
Plain-English Specialty	Board-Certified Emergency Medicine Physician (ER / Trauma Doctor) NUCC Code: `207PE0004X` (Emergency Medicine, Emergency Medical Services)
Certifying / Licensing Body	American Board of Emergency Medicine (ABEM)
Practice Location Address	11058 NELSON ROAD NE, MOSES LAKE, WA, 98837-8812
Practice Telephone / Fax	Tel: (509) 765-3175 \| Fax: (509) 765-3550
Administrative Mailing Address	4251 KIPLING STREET, WHEATRIDGE, CO, 80033
Enumeration & Last Sync	Enumerated: 2006-01-09 \| CMS Record Updated: 2025-09-11
Authorized Official	ROGER HANSEN (Fire Chief)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

11058 NELSON ROAD NE, MOSES LAKE, WA, 98837-8812

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Plain-English Taxonomy & CMS Crosswalk (207PE0004X)

What Does Taxonomy Code 207PE0004X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207PE0004X translates to:
"Board-Certified Emergency Medicine Physician (ER / Trauma Doctor)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 93 (Physician/Emergency Medicine)
Certifying / Accrediting Authority: American Board of Emergency Medicine (ABEM)
Clinical Scope: Immediate life-or-limb emergencies, severe chest pain, stroke symptoms, deep contaminated wounds needing tetanus prophylaxis, or severe dehydration.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (GRANT COUNTY FIRE DISTRICT NO )

Typical CPT / Diagnostic Procedures:

Level 4 & Level 5 Emergency Department Resuscitation (CPT 99284–99285)
Point-of-Care Emergency Ultrasound (eFAST), Intubation & Central Line Placement
Acute Laceration Repair, Tetanus Prophylaxis & Fracture Splinting

Common Therapeutic Classes:

Epinephrine Auto-Injectors / IV Infusions, Atropine & Amiodarone
Tetanus Toxoid / Tdap & Tetanus Immunoglobulin (TIG)
Empiric Sepsis Antibiotics, Parenteral Ketorolac & Ondansetron

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`341600000X` — Ambulance Plain English: Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance	State: WA \| License: `13D05` \| Primary: Secondary
`207PE0004X` — Emergency Medicine, Emergency Medical Services Plain English: Board-Certified Emergency Medicine Physician (ER / Trauma Doctor)	State: WA \| License: `13M18` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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GRANT COUNTY FIRE DISTRICT NO (NPI #1366420341)