1205808953 NPI number — BAINBRIDGE ISLAND AMBULANCE ASSOCIATION INC

Table of content: (NPI 1205808953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205808953 NPI number — BAINBRIDGE ISLAND AMBULANCE ASSOCIATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAINBRIDGE ISLAND AMBULANCE ASSOCIATION 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:
1205808953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2012
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:
360-394-7030
Provider Business Mailing Address Fax Number:
360-394-7097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
911 HILDEBRAND LN NE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
BAINBRIDGE ISLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98110-2859
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:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEYKE
Authorized Official First Name:
RENA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL SERVICES OFFICER
Authorized Official Telephone Number:
206-842-2676

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  18X01 , 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: XMTE06444 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9145400 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: BA1537 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 806978000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0089673 . This is a "L&I AND CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 590161198 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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