Provider Demographics
NPI:1619021813
Name:METRO WEST AMBULANCE, INC
Entity Type:Organization
Organization Name:METRO WEST AMBULANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:FUITEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-648-6658
Mailing Address - Street 1:609 NW COAST ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3409
Mailing Address - Country:US
Mailing Address - Phone:503-648-6658
Mailing Address - Fax:503-693-3216
Practice Address - Street 1:5475 NE DAWSON CREEK DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5797
Practice Address - Country:US
Practice Address - Phone:503-648-6658
Practice Address - Fax:503-693-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112433OtherKAISER
AKTX3490RMedicaid
UT006214000OtherREGENCE BCBS OF OREGON
CAXMTE06264Medicaid
WA191618800OtherDEPT OF LABOR & INDUSTRY
AZ0441184OtherACS CLAIMS
AZ346793Medicaid
WA9124504Medicaid
AKGA3490RMedicaid
OR121590Medicaid
WI448760OtherCHAMPUS TRICARE
WA8940085OtherCRIME VICTIMS COMP PROGRA
OR331391OtherPROVIDENCE HEALTH PLAN
VA626457OtherANTHEM BCBS
GA8100204OtherUNITED HEALTH CARE
TX8100209OtherEVERCARE
IDA112001Medicaid
WAOR0000D100344OtherSTATE OF WA LABOR & IND.
WA191618800OtherDEPT OF LABOR & INDUSTRY
UT006214000OtherREGENCE BCBS OF OREGON