Provider Demographics
NPI:1689721250
Name:CITY OF PULLMAN
Entity Type:Organization
Organization Name:CITY OF PULLMAN
Other - Org Name:CITY OF PULLMAN AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:MULHOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-338-3206
Mailing Address - Street 1:325 SE PARADISE ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2631
Mailing Address - Country:US
Mailing Address - Phone:509-332-8172
Mailing Address - Fax:
Practice Address - Street 1:620 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2135
Practice Address - Country:US
Practice Address - Phone:509-332-8172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA38M103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003314200Medicaid
ID1001033OtherID STATE INS FUND
WA9177908Medicaid
WA243081400OtherUS DEPT OF LABOR
WA5900046717OtherRAILROAD MEDICARE
WA8911082OtherL&I CRIME VICTIMS
WA28606OtherL&I PROVIDER #
WAG000300230OtherMEDICARE PTAN