1205388444 NPI number — BAINBRIDGE ADVANCED CARE AMBULANCE

Table of content: (NPI 1205388444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205388444 NPI number — BAINBRIDGE ADVANCED CARE AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAINBRIDGE ADVANCED CARE AMBULANCE
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:
6
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:
1205388444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-394-7010
Provider Business Mailing Address Fax Number:
360-394-7099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 ERICKSEN AVE NE
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
BAINBRIDGE ISLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98110-2854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-842-2676
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WHYTE
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD PRESIDENT
Authorized Official Telephone Number:
206-842-2676

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  18X05 , 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)





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