=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801896873
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF GRAND COULEE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2005
-----------------------------------------------------
Last Update Date | 03/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 306 MIDWAY AVENUE
-----------------------------------------------------
City | GRAND COULEE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99133-0180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-633-1150
-----------------------------------------------------
Fax | 509-633-1370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3510
-----------------------------------------------------
City | SILVERDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98383-3510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-394-7030
-----------------------------------------------------
Fax | 360-394-7097
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AMBULANCE DIRECTOR
-----------------------------------------------------
Name | RICHARD PARIS
-----------------------------------------------------
Credential | EMT
-----------------------------------------------------
Telephone | 509-633-1150
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 13M05
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------