Provider Demographics
NPI:1821189325
Name:CITY OF COULEE DAM
Entity Type:Organization
Organization Name:CITY OF COULEE DAM
Other - Org Name:TOWN OF COULEE DAM AMBULANCE-COULEE DAM FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-633-0320
Mailing Address - Street 1:300 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:COULEE DAM
Mailing Address - State:WA
Mailing Address - Zip Code:99116-1419
Mailing Address - Country:US
Mailing Address - Phone:509-633-0320
Mailing Address - Fax:
Practice Address - Street 1:300 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:COULEE DAM
Practice Address - State:WA
Practice Address - Zip Code:99116-1419
Practice Address - Country:US
Practice Address - Phone:509-633-0320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA24M113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0028988OtherWASHINGTON L&I
WA9146309Medicaid
WAG000315062Medicare PIN