Provider Demographics
NPI:1205808953
Name:BAINBRIDGE ISLAND AMBULANCE ASSOCIATION INC
Entity type:Organization
Organization Name:BAINBRIDGE ISLAND AMBULANCE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SERVICES OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-842-2676
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 1:911 HILDEBRAND LN NE
Practice Address - Street 2:SUITE 104
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2859
Practice Address - Country:US
Practice Address - Phone:206-842-2676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA18X013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXMTE06444Medicaid
WA9145400Medicaid
WABA1537OtherREGENCE
ID806978000Medicaid
WA0089673OtherL&I AND CRIME VICTIMS
WA590161198OtherRAILROAD MEDICARE PTAN
CAXMTE06444Medicaid