Provider Demographics
NPI:1063682342
Name:DOUGLAS COUNTY HOSPITAL DISTRICT 2
Entity Type:Organization
Organization Name:DOUGLAS COUNTY HOSPITAL DISTRICT 2
Other - Org Name:WATERVILLE AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELONNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:REJNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-745-8448
Mailing Address - Street 1:117 SO CHELAN ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98858
Mailing Address - Country:US
Mailing Address - Phone:509-745-8448
Mailing Address - Fax:509-745-8448
Practice Address - Street 1:117 SO CHELAN ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:WA
Practice Address - Zip Code:98858
Practice Address - Country:US
Practice Address - Phone:509-745-8448
Practice Address - Fax:509-745-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261Q00000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
503803Medicare Oscar/Certification