1619021813 NPI number — METRO WEST AMBULANCE, INC

Table of content: (NPI 1619021813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619021813 NPI number — METRO WEST AMBULANCE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO WEST 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:
1619021813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 NW COAST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97365-3409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-648-6658
Provider Business Mailing Address Fax Number:
503-693-3216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5475 NE DAWSON CREEK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97124-5797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-648-6658
Provider Business Practice Location Address Fax Number:
503-693-3216
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FUITEN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-648-6658

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112433 . This is a "KAISER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TX3490R , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006214000 . This is a "REGENCE BCBS OF OREGON" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: XMTE06264 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 191618800 . This is a "DEPT OF LABOR & INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0441184 . This is a "ACS CLAIMS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 346793 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9124504 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GA3490R , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121590 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 448760 . This is a "CHAMPUS TRICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 8940085 . This is a "CRIME VICTIMS COMP PROGRA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 331391 . This is a "PROVIDENCE HEALTH PLAN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 626457 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8100204 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 8100209 . This is a "EVERCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: A112001 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: OR0000D100344 . This is a "STATE OF WA LABOR & IND." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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