Provider Demographics
NPI:1710024294
Name:LEWIS COUNTY
Entity Type:Organization
Organization Name:LEWIS COUNTY
Other - Org Name:SALKUM AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-262-3320
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:NAPAVINE
Mailing Address - State:WA
Mailing Address - Zip Code:98565-0259
Mailing Address - Country:US
Mailing Address - Phone:360-262-3320
Mailing Address - Fax:360-262-3893
Practice Address - Street 1:2490 U.S. HWY 12
Practice Address - Street 2:
Practice Address - City:SALKUM
Practice Address - State:WA
Practice Address - Zip Code:98582
Practice Address - Country:US
Practice Address - Phone:360-985-2828
Practice Address - Fax:360-985-7475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWIS COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA21D083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9140807Medicaid