Provider Demographics
NPI:1477548253
Name:CITY OF KENNEWICK
Entity Type:Organization
Organization Name:CITY OF KENNEWICK
Other - Org Name:CITY OF KENNEWICK AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-585-4263
Mailing Address - Street 1:PO BOX 6108
Mailing Address - Street 2:210 W 6TH AVE
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5649
Mailing Address - Country:US
Mailing Address - Phone:509-585-4379
Mailing Address - Fax:509-585-4254
Practice Address - Street 1:210 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5649
Practice Address - Country:US
Practice Address - Phone:509-585-4379
Practice Address - Fax:505-585-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA03M02341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA590004614OtherRAILROAD MEDICARE
WA6153602Medicaid
WA8906318OtherCRIME VICTIMS
OR103705Medicaid
WA16689OtherLABOR & INDUSTRIES
WA9153602Medicaid
WA16689OtherL&I
WA590004614OtherRAILROAD MEDICARE