Healthcare Provider Details

I. General information

NPI: 1720004112
Provider Name (Legal Business Name): CITY OF WALLA WALLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N WILBUR AVE
WALLA WALLA WA
99362-2548
US

IV. Provider business mailing address

170 N WILBUR AVE
WALLA WALLA WA
99362-2548
US

V. Phone/Fax

Practice location:
  • Phone: 509-529-4083
  • Fax: 509-529-0694
Mailing address:
  • Phone: 509-529-4083
  • Fax: 509-529-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number36M04
License Number StateWA

VIII. Authorized Official

Name: MR. FRED HECTOR
Title or Position: DEPUTY CHIEF OF EMS
Credential:
Phone: 509-524-4630