Healthcare Provider Details

I. General information

NPI: 1619974615
Provider Name (Legal Business Name): EASTERN WYOMING AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 W MARIPOSA PKWY
WHEATLAND WY
82201-3112
US

IV. Provider business mailing address

2450 W MARIPOSA PKWY
WHEATLAND WY
82201-3112
US

V. Phone/Fax

Practice location:
  • Phone: 307-322-5424
  • Fax:
Mailing address:
  • Phone: 307-322-5424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number127
License Number StateWY

VIII. Authorized Official

Name: WADE WELLS
Title or Position: PRESIDENT
Credential: NREMT-P
Phone: 307-322-5424