1730280447 NPI number — PACIFIC WEST AMBULANCE INC

Table of content: (NPI 1730280447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730280447 NPI number — PACIFIC WEST AMBULANCE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC 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:
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:
1730280447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2015
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:
541-265-3175
Provider Business Mailing Address Fax Number:
541-574-5209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 NW COAST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-265-3175
Provider Business Practice Location Address Fax Number:
541-574-5209
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FUITEN
Authorized Official First Name:
J
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-648-6658

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2102 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 343900000X , with the licence number: 2102 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9029034 . This is a "WA DEPT SOCIAL & HLTH SVC" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 154682 . This is a "OREGON HEALTH PLAN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 590004562 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 806591000 . This is a "IDAHO EDS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 080835000 . This is a "BLUE CROSS OF OREGON" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 100502357 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 233331 . This is a "OMAP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 96000625 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107959 . This is a "WASHINGTON DEPT LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: N266969 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 154682 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 519374 . This is a "ODS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9029034 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0152169 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 037140000 . This is a "BLUE CROSS OUT OF STATE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0443326 . This is a "CONSULTEC INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 916801 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: XMTE06451 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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