Provider Demographics
NPI:1922215714
Name:MEDLAW CONFIDENTIAL PLLC
Entity Type:Organization
Organization Name:MEDLAW CONFIDENTIAL PLLC
Other - Org Name:LIFELINK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, CHIEF PARAMEDIC
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:CRITICAL CARE PM
Authorized Official - Phone:360-385-0812
Mailing Address - Street 1:PO BOX 1922
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-0064
Mailing Address - Country:US
Mailing Address - Phone:360-385-0812
Mailing Address - Fax:
Practice Address - Street 1:824 GRANT ST
Practice Address - Street 2:SUITE 5
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2477
Practice Address - Country:US
Practice Address - Phone:360-385-0812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA16X053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0176344OtherLABOR & INDUSTRIES PIN
WA9054578Medicaid
WA9054578Medicaid