Provider Demographics
NPI:1881697654
Name:NORTH COUNTRY EMERGENCY MEDICAL SERVICES
Entity type:Organization
Organization Name:NORTH COUNTRY EMERGENCY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-686-3271
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:YACOLT
Mailing Address - State:WA
Mailing Address - Zip Code:98675-0299
Mailing Address - Country:US
Mailing Address - Phone:360-686-3271
Mailing Address - Fax:360-686-8127
Practice Address - Street 1:300 W HOAG ST
Practice Address - Street 2:
Practice Address - City:YACOLT
Practice Address - State:WA
Practice Address - Zip Code:98675-5604
Practice Address - Country:US
Practice Address - Phone:360-686-3271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6010099353416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR911357973OtherREGENCE BC/BS
OR166025OtherOMAP
WA27228OtherDEPT OF LABOR & INDUSTRIE
WA9063603Medicaid
OR166025OtherOMAP