Provider Demographics
NPI:1154305522
Name:WAITSBURG AMBULANCE SERVICE
Entity Type:Organization
Organization Name:WAITSBURG AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:AEMT
Authorized Official - Phone:509-337-6149
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:WAITSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:99361-0242
Mailing Address - Country:US
Mailing Address - Phone:509-337-6149
Mailing Address - Fax:509-337-6220
Practice Address - Street 1:765 PRESTON AVE
Practice Address - Street 2:
Practice Address - City:WAITSBURG
Practice Address - State:WA
Practice Address - Zip Code:99361-7723
Practice Address - Country:US
Practice Address - Phone:509-337-6149
Practice Address - Fax:509-337-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA36X033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0166650OtherLABOR AND INDUSTRIES
WA9053349Medicaid
WAP00087502Medicare ID - Type UnspecifiedMEDICARE RAILROAD
WAWA04981Medicare ID - Type UnspecifiedTRADING PARTNER ID
WA9053349Medicaid