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General NPI Number Information
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NPI Number | 1306143342
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Entity Type | Organization
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Legal Business Name | SAM'S AMBULETTE SERVICE, LLC
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Dates
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Enumeration Date | 02/25/2011
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 25611 16TH AVE S
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City | DES MOINES
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State | WA
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Zip | 98198-8953
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Country | US
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Telephone | 253-249-8300
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Fax | 206-429-3122
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Provider Business Mailing Address
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Address Line | PO BOX 98724
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City | DES MOINES
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State | WA
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Zip | 98198-0724
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Country | US
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Telephone | 253-249-8300
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Fax | 206-429-3122
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | MR. ISMAEL TABALNO
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Credential |
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Telephone | 253-249-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 05087
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License Number State | WA
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