Provider Demographics
NPI:1518176742
Name:OLYMPIC AMBULANCE SERVICE INC.
Entity Type:Organization
Organization Name:OLYMPIC AMBULANCE SERVICE INC.
Other - Org Name:OLYMPIC OXYGEN SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-681-4482
Mailing Address - Street 1:601 W HENDRICKSON RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3015
Mailing Address - Country:US
Mailing Address - Phone:360-681-4482
Mailing Address - Fax:360-681-7461
Practice Address - Street 1:540 W HENDRICKSON RD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3013
Practice Address - Country:US
Practice Address - Phone:360-681-4482
Practice Address - Fax:360-681-7461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLYMPIC AMBULANCE SERVICE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA05X03332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9056094Medicaid
WA0491410001Medicare NSC
WA0491410001Medicare PIN