Provider Demographics
NPI:1255403051
Name:TONASKET EMERGENCY MEDICAL SERVICES
Entity type:Organization
Organization Name:TONASKET EMERGENCY MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MSO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-560-0080
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:509-560-0080
Mailing Address - Fax:877-398-3107
Practice Address - Street 1:18 EAST FOURTH STREET
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855
Practice Address - Country:US
Practice Address - Phone:509-560-0080
Practice Address - Fax:877-398-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA24X093416L0300X
WA22X013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9055591Medicaid
WA187490OtherLABOR AND INDUSTRIES
WA9055591Medicaid