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General NPI Number Information
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NPI Number | 1972832806
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Entity Type | Organization
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Legal Business Name | VASE AMBULANCE ASSOCIATES
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Dates
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Enumeration Date | 12/24/2009
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 168 ELK ST
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-5241
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Country | US
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Telephone | 307-371-1241
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Fax | 307-362-5139
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Provider Business Mailing Address
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Address Line | 401 BRIDGER AVE
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-5209
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Country | US
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Telephone | 307-371-1241
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Fax | 307-362-5139
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Authorized Official
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Title or Position | CO-OWNER
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Name | JACKSON BRUCE WATERS
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Credential | RN, BSN, CLNC
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Telephone | 307-371-1241
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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 | 68
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License Number State | WY
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