Provider Demographics
NPI:1932272390
Name:AMBER COAST
Entity Type:Organization
Organization Name:AMBER COAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CERTIFIED FITTER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-924-3605
Mailing Address - Street 1:PO BOX 14743
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99214-0743
Mailing Address - Country:US
Mailing Address - Phone:509-924-3605
Mailing Address - Fax:509-924-3605
Practice Address - Street 1:11007 E FERRET DR
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-9451
Practice Address - Country:US
Practice Address - Phone:509-924-3605
Practice Address - Fax:509-924-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602308688332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4897320001Medicare ID - Type Unspecified