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General NPI Number Information
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NPI Number | 1750349460
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Entity Type | Organization
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Legal Business Name | SAN JUAN ISLAND EMERGENCY MEDICAL SERVICE
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 1079 SPRING ST
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City | FRIDAY HARBOR
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State | WA
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Zip | 98250-9756
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Country | US
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Telephone | 360-378-5152
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Fax | 360-378-3583
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Provider Business Mailing Address
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Address Line | PO BOX 2178
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City | FRIDAY HARBOR
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State | WA
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Zip | 98250-2178
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Country | US
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Telephone | 360-378-5152
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Fax | 360-378-3583
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | CADY C DAVIES
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Credential | EMT
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Telephone | 360-378-5152
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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 | 28X02
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License Number State | WA
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