=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497750434
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF MOSES LAKE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2005
-----------------------------------------------------
Last Update Date | 07/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 E 3RD AVE
-----------------------------------------------------
City | MOSES LAKE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98837-5904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-765-2204
-----------------------------------------------------
Fax | 509-765-2291
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1579
-----------------------------------------------------
City | MOSES LAKE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98837-0244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-765-2204
-----------------------------------------------------
Fax | 509-765-2291
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | MR. THOMAS H TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-765-2204
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 13MO8
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------