Healthcare Provider Details

I. General information

NPI: 1477185163
Provider Name (Legal Business Name): ERIC KOREIS MS, EMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 COMMERCE AVE
LONGVIEW WA
98632-2416
US

IV. Provider business mailing address

151 ALAMO RD
CASTLE ROCK WA
98611-9599
US

V. Phone/Fax

Practice location:
  • Phone: 360-442-5514
  • Fax:
Mailing address:
  • Phone: 360-562-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberES00115784
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: