Provider Demographics
NPI:1467488577
Name:OLYMPIC AMBULANCE SERVICE INC.
Entity Type:Organization
Organization Name:OLYMPIC AMBULANCE SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-683-3350
Mailing Address - Street 1:601 WEST HENDRICKSON ROAD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382
Mailing Address - Country:US
Mailing Address - Phone:360-683-3350
Mailing Address - Fax:360-681-4824
Practice Address - Street 1:601 WEST HENDRICKSON ROAD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382
Practice Address - Country:US
Practice Address - Phone:360-683-3350
Practice Address - Fax:360-582-9824
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLYMPIC AMBULANCE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-23
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA05X033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9243304Medicaid