1730280447 NPI number — PACIFIC WEST AMBULANCE INC

Table of content: ALI SANAULLAH CHOUDHRY MD (NPI 1871237081)

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

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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