Provider Demographics
NPI:1720004112
Name:CITY OF WALLA WALLA
Entity Type:Organization
Organization Name:CITY OF WALLA WALLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF OF EMS
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-529-4083
Mailing Address - Street 1:170 N WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2548
Mailing Address - Country:US
Mailing Address - Phone:509-529-4083
Mailing Address - Fax:509-529-0694
Practice Address - Street 1:170 N WILBUR AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2548
Practice Address - Country:US
Practice Address - Phone:509-529-4083
Practice Address - Fax:509-529-0694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA36M043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA590161247OtherRAILROAD MEDICARE
WA029454OtherOREGON MEDICAID
WA193657900OtherOFFICE WORKERS COMP
WA9150509Medicaid
WA12755OtherWASHINGTON L&I
WA8901205OtherCRIME VICTIM PROVIDER NUM
WAITA9023839OtherINVOLUNTARY
WA9150509Medicaid