Provider Demographics
NPI:1972832806
Name:VASE AMBULANCE ASSOCIATES
Entity Type:Organization
Organization Name:VASE AMBULANCE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CLNC
Authorized Official - Phone:307-371-1241
Mailing Address - Street 1:401 BRIDGER AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5209
Mailing Address - Country:US
Mailing Address - Phone:307-371-1241
Mailing Address - Fax:307-362-5139
Practice Address - Street 1:168 ELK ST
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5241
Practice Address - Country:US
Practice Address - Phone:307-371-1241
Practice Address - Fax:307-362-5139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY683416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport