Healthcare Provider Details

I. General information

NPI: 1467488577
Provider Name (Legal Business Name): OLYMPIC AMBULANCE SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WEST HENDRICKSON ROAD
SEQUIM WA
98382
US

IV. Provider business mailing address

601 WEST HENDRICKSON ROAD
SEQUIM WA
98382
US

V. Phone/Fax

Practice location:
  • Phone: 360-683-3350
  • Fax: 360-582-9824
Mailing address:
  • Phone: 360-683-3350
  • Fax: 360-681-4824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number05X03
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9243304
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: WENDY L BLACK
Title or Position: BILLING MANAGER
Credential:
Phone: 360-683-3350