Provider Demographics
NPI:1619974615
Name:EASTERN WYOMING AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:EASTERN WYOMING AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:307-322-5424
Mailing Address - Street 1:2450 W MARIPOSA PKWY
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-3112
Mailing Address - Country:US
Mailing Address - Phone:307-322-5424
Mailing Address - Fax:
Practice Address - Street 1:2450 W MARIPOSA PKWY
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-3112
Practice Address - Country:US
Practice Address - Phone:307-322-5424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1273416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW305750Medicare ID - Type Unspecified