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General NPI Number Information
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NPI Number | 1598831273
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Entity Type | Organization
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Legal Business Name | WILT'S EMERGENCY SERVICE AND TRANSPORT, INC.
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1290 NE CEDAR ST
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City | ROSEBURG
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State | OR
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Zip | 97470-2016
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Country | US
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Telephone | 541-673-0632
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Fax | 541-672-7493
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Provider Business Mailing Address
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Address Line | 1290 NE CEDAR ST
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City | ROSEBURG
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State | OR
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Zip | 97470-2016
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Country | US
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Telephone | 541-673-0632
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Fax | 541-672-7493
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD M WILT
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Credential | OWNER
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Telephone | 541-673-0632
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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 | 3416L0300X
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License Number State | OR
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