Healthcare Provider Details

I. General information

NPI: 1013903558
Provider Name (Legal Business Name): ISLAND EMERGENCY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12412 SW COVE RD
VASHON WA
98070-3704
US

IV. Provider business mailing address

PO BOX 204
VASHON WA
98070-0204
US

V. Phone/Fax

Practice location:
  • Phone: 206-463-9671
  • Fax: 206-463-6671
Mailing address:
  • Phone: 206-463-9671
  • Fax: 206-463-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number17X22
License Number StateWA

VIII. Authorized Official

Name: MS. JOLENE M. LAMB
Title or Position: PRESIDENCE
Credential:
Phone: 206-463-9671