1013903558 NPI number — ISLAND EMERGENCY CARE INC.

Table of content: (NPI 1013903558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013903558 NPI number — ISLAND EMERGENCY CARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISLAND EMERGENCY CARE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IEC AMBULANCE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013903558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VASHON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98070-0204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-463-9671
Provider Business Mailing Address Fax Number:
206-463-6671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12412 SW COVE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VASHON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98070-3704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-463-9671
Provider Business Practice Location Address Fax Number:
206-463-6671
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LAMB
Authorized Official First Name:
JOLENE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENCE
Authorized Official Telephone Number:
206-463-9671

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  17X22 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9038134 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51934 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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