Healthcare Provider Details

I. General information

NPI: 1881125284
Provider Name (Legal Business Name): AMBASSADOR'S HEALTH ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 STOLLER RD
TROUT LAKE WA
98650-9712
US

IV. Provider business mailing address

4 STOLLER RD
TROUT LAKE WA
98650-9712
US

V. Phone/Fax

Practice location:
  • Phone: 509-395-2061
  • Fax:
Mailing address:
  • Phone: 509-395-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO157483
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200750145NP
License Number StateOR

VIII. Authorized Official

Name: TOBIN D RUMMEL
Title or Position: OWNER
Credential: D.O.
Phone: 509-395-2061