Provider Demographics
NPI:1982835625
Name:CENTRAL VALLEY AMBULANCE AUTHORITY
Entity Type:Organization
Organization Name:CENTRAL VALLEY AMBULANCE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-856-7152
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3510
Mailing Address - Country:US
Mailing Address - Phone:360-394-7030
Mailing Address - Fax:360-394-7097
Practice Address - Street 1:2015 HOSPITAL DR
Practice Address - Street 2:UNIT A
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-4327
Practice Address - Country:US
Practice Address - Phone:360-856-7152
Practice Address - Fax:360-856-7187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA29X073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0252279OtherL&I-CRIME VICTIMS
WAP00774086OtherRAILROAD MEDICARE
WA9063306Medicaid
WA615137700OtherOWCP
WA9063306Medicaid