Provider Demographics
NPI:1679770549
Name:PLATINUM NINE HOLDINGS LLC
Entity Type:Organization
Organization Name:PLATINUM NINE HOLDINGS LLC
Other - Org Name:NORTHWEST AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-480-2929
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3510
Mailing Address - Country:US
Mailing Address - Phone:360-394-7030
Mailing Address - Fax:360-394-7097
Practice Address - Street 1:706 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4548
Practice Address - Country:US
Practice Address - Phone:877-480-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA31X123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA615020800OtherOWCP
WA0226767OtherL&I AND CRIME VICTIMS
WA9060849Medicaid
WAP00418792OtherRAILROAD MEDICARE
G8867435Medicare PIN