Provider Demographics
NPI:1023188091
Name:MID COLUMBIA AMBULANCE LLC
Entity Type:Organization
Organization Name:MID COLUMBIA AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EGLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-586-6982
Mailing Address - Street 1:PO BOX 6718
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-0640
Mailing Address - Country:US
Mailing Address - Phone:509-586-6982
Mailing Address - Fax:509-586-8314
Practice Address - Street 1:822 W JOHN DAY AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3577
Practice Address - Country:US
Practice Address - Phone:509-586-6982
Practice Address - Fax:509-586-8314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9056169Medicaid
WA294920OtherPREMERA BC
WA294920OtherPREMERA BC
WAG8807533Medicare PIN