=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932272390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMBER COAST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 06/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11007 E FERRET DR
-----------------------------------------------------
City | SPOKANE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99206-9451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-924-3605
-----------------------------------------------------
Fax | 509-924-3605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 14743
-----------------------------------------------------
City | SPOKANE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99214-0743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-924-3605
-----------------------------------------------------
Fax | 509-924-3605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER CERTIFIED FITTER
-----------------------------------------------------
Name | MARILYN J TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-924-3605
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 602308688
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------