1376537027 NPI number — WASHINGTON COUNTY AMBULANCE, INC.

Table of content: (NPI 1376537027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376537027 NPI number — WASHINGTON COUNTY AMBULANCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON COUNTY AMBULANCE, 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:
Provider Other Organization Name Type Code:
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:
1376537027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 N 8TH AVE
Provider Second Line Business Mailing Address:
PO BOX 371
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52353-2618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-653-2047
Provider Business Mailing Address Fax Number:
319-653-3344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 N 8TH AVE
Provider Second Line Business Practice Location Address:
BOX 371
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52353-0371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-653-2047
Provider Business Practice Location Address Fax Number:
319-653-3344
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
319-653-2047

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  2920100 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0192898 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0419945 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com