PACIFIC WEST AMBULANCE INC

Provider Demographics

• NPI: 1730280447
• Name: PACIFIC WEST AMBULANCE INC
• Entity Type: Organization
• Organization Name: PACIFIC WEST AMBULANCE INC
• Other - Org Name: LINCOLN CITY AMBULANCE
• Other - Org Type: Former Legal Business Name
• Authorized Official - Title/Position: OWNER
• Authorized Official - First Name: J
• Authorized Official - Middle Name: D
• Authorized Official - Last Name: FUITEN
• Authorized Official - Phone: 541-648-6658
• Mailing Address - Street 1: 609 NW COAST ST
• Mailing Address - City: NEWPORT
• Mailing Address - State: OR
• Mailing Address - Zip Code: 97365-3409
• Mailing Address - Country: US
• Mailing Address - Phone: 541-265-3175
• Mailing Address - Fax: 541-574-5209
• Practice Address - Street 1: 609 NW COAST ST
• Practice Address - City: NEWPORT
• Practice Address - State: OR
• Practice Address - Zip Code: 97365
• Practice Address - Country: US
• Practice Address - Phone: 541-265-3175
• Practice Address - Fax: 541-574-5209
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-09-26
• Last Update Date: 2015-09-02

Provider Licenses

State	License ID	Taxonomies
OR	2102	3416L0300X, 343900000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3416L0300X	Transportation Services	Ambulance	Land Transport
No	343900000X	Transportation Services	Non-emergency Medical Transport (VAN)

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WA	9029034	Other	WA DEPT SOCIAL & HLTH SVC
OR	154682	Other	OREGON HEALTH PLAN
	590004562	Other	RAILROAD MEDICARE
ID	806591000	Other	IDAHO EDS
OR	080835000	Other	BLUE CROSS OF OREGON
NV	100502357	Medicaid
OR	233331	Other	OMAP
CO	96000625	Medicaid
	107959	Other	WASHINGTON DEPT LABOR
FL	N266969	Medicaid
OR	154682	Medicaid
	519374	Other	ODS HEALTH PLAN
WA	9029034	Medicaid
OH	0152169	Medicaid
	037140000	Other	BLUE CROSS OUT OF STATE
	0443326	Other	CONSULTEC INC
AZ	916801	Medicaid
CA	XMTE06451	Medicaid
CA	XMTE06451	Medicaid
OR	R0000RGCFR	Medicare PIN