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General NPI Number Information
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NPI Number | 1174572739
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Entity Type | Organization
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Legal Business Name | ADVANCED LIFE SYSTEMS, INC.
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 2106 W WASHINGTON AVE SUITE #3
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City | YAKIMA
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State | WA
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Zip | 98903-1272
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Country | US
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Telephone | 509-574-8445
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Fax | 509-574-4040
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Provider Business Mailing Address
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Address Line | 3505 OCEAN BLVD SE
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City | COOS BAY
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State | OR
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Zip | 97420-3537
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Country | US
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Telephone | 541-266-4300
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Fax | 541-267-0831
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Authorized Official
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Title or Position | OWNER
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Name | JAMES FUITEN
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Credential |
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Telephone | 503-648-6658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 39X05
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License Number State | WA
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