Provider Demographics
NPI:1467674036
Name:TOWN OF ROSALIA AMBULANCE SERVICES
Entity Type:Organization
Organization Name:TOWN OF ROSALIA AMBULANCE SERVICES
Other - Org Name:ROSALIA AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-523-3151
Mailing Address - Street 1:607 SOUTH WHITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROSALIA
Mailing Address - State:WA
Mailing Address - Zip Code:99170
Mailing Address - Country:US
Mailing Address - Phone:509-523-3151
Mailing Address - Fax:509-523-2302
Practice Address - Street 1:607 SOUTH WHITMAN AVE
Practice Address - Street 2:
Practice Address - City:ROSALIA
Practice Address - State:WA
Practice Address - Zip Code:99170
Practice Address - Country:US
Practice Address - Phone:509-523-3151
Practice Address - Fax:509-523-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA38M11341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91215303Medicaid
WA756590417Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WA91215303Medicaid