Healthcare Provider Details

I. General information

NPI: 1821189325
Provider Name (Legal Business Name): CITY OF COULEE DAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LINCOLN AVE
COULEE DAM WA
99116-1419
US

IV. Provider business mailing address

300 LINCOLN AVE
COULEE DAM WA
99116-1419
US

V. Phone/Fax

Practice location:
  • Phone: 509-633-0320
  • Fax:
Mailing address:
  • Phone: 509-633-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number24M11
License Number StateWA

VIII. Authorized Official

Name: MR. BEN ALLING
Title or Position: EMS CHIEF
Credential:
Phone: 509-633-0320