Provider Demographics
NPI:1376537027
Name:WASHINGTON COUNTY AMBULANCE, INC.
Entity Type:Organization
Organization Name:WASHINGTON COUNTY AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-653-2047
Mailing Address - Street 1:1120 N 8TH AVE
Mailing Address - Street 2:PO BOX 371
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-2618
Mailing Address - Country:US
Mailing Address - Phone:319-653-2047
Mailing Address - Fax:319-653-3344
Practice Address - Street 1:1120 N 8TH AVE
Practice Address - Street 2:BOX 371
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-0371
Practice Address - Country:US
Practice Address - Phone:319-653-2047
Practice Address - Fax:319-653-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2920100341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0192898Medicaid
IA0419945Medicaid
IA0419945Medicaid