Healthcare Provider Details

I. General information

NPI: 1881697654
Provider Name (Legal Business Name): NORTH COUNTRY EMERGENCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HOAG ST
YACOLT WA
98675-5604
US

IV. Provider business mailing address

PO BOX 189
YACOLT WA
98675-0299
US

V. Phone/Fax

Practice location:
  • Phone: 360-686-3271
  • Fax:
Mailing address:
  • Phone: 360-686-3271
  • Fax: 360-686-8127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number601009935
License Number StateWA

VIII. Authorized Official

Name: MS. KIM PITTS
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 360-686-3271