Provider Demographics
NPI:1598831273
Name:WILT'S EMERGENCY SERVICE AND TRANSPORT, INC.
Entity Type:Organization
Organization Name:WILT'S EMERGENCY SERVICE AND TRANSPORT, INC.
Other - Org Name:W.E.S.T. AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILT
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:541-673-0632
Mailing Address - Street 1:1290 NE CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-2016
Mailing Address - Country:US
Mailing Address - Phone:541-673-0632
Mailing Address - Fax:541-672-7493
Practice Address - Street 1:1290 NE CEDAR ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-2016
Practice Address - Country:US
Practice Address - Phone:541-673-0632
Practice Address - Fax:541-672-7493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3416L0300X3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0086637OtherSTATE OF WA DEPT. OF LABO
OR285353Medicaid
SCQAB128Medicaid
FL7347272Medicaid
AR1073073Medicaid
OH2476888Medicaid
WA9023862Medicaid
CAXMTE05630Medicaid
WA9023862Medicaid