Provider Demographics
NPI:1780874511
Name:PE ELL AMBULANCE AUXILLARY
Entity type:Organization
Organization Name:PE ELL AMBULANCE AUXILLARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAFCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-880-0036
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 1:800 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PE ELL
Practice Address - State:WA
Practice Address - Zip Code:98572
Practice Address - Country:US
Practice Address - Phone:360-520-2046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA21M053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0239919OtherL&I AND CRIME VICTIMS
WAP00840008OtherRAILROAD MEDICARE
WA9062365Medicaid
WA9062365Medicaid