Provider Demographics
NPI:1497750434
Name:CITY OF MOSES LAKE
Entity Type:Organization
Organization Name:CITY OF MOSES LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-765-2204
Mailing Address - Street 1:PO BOX 1579
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-0244
Mailing Address - Country:US
Mailing Address - Phone:509-765-2204
Mailing Address - Fax:509-765-2291
Practice Address - Street 1:701 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-5904
Practice Address - Country:US
Practice Address - Phone:509-765-2204
Practice Address - Fax:509-765-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA13MO83416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9051855Medicaid
WA590014752Medicare ID - Type UnspecifiedRR MEDICARE
WA9051855Medicaid