Tekoa Community Ambulance

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

TEKOA COMMUNITY AMBULANCE

Practice address

S 226 Ramsey STR.
Tekoa, WA 99033-0597

Phone

(509) 284-2423

NPI assigned

Jun 25, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dwayne Groom

Title

President

Phone

(509) 284-2246

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023214293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "S. 226 RAMSEY ST.",
            "address_2": "PO BOX 597",
            "city": "TEKOA",
            "state": "WA",
            "postal_code": "990330597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "S 226 RAMSEY STR.",
            "city": "TEKOA",
            "state": "WA",
            "postal_code": "990330597",
            "telephone_number": "509-284-2423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEKOA COMMUNITY AMBULANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GROOM",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-284-2246",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9257601",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peter J Martin
• Melissa Anne Osborne
• Peter J Martin (Tekoa Rural Health Clinic)
• Peter J. Martin (Tekoa Medical Clinic)
• Patricia L Primmer
• Tekoa Medical Foundation Inc (Tekoa Care Center)
• Tekoa Operations LLC Tekoa Care Center (Tekoa Care Center)
• Tekoa RX LLC (Tekoa Pharmacy)
• Tekoa School District

• Land Ambulance in Tekoa, WA
• Providers in Tekoa, WA by specialty
• Land Ambulance in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.