NPIMap

Organization Active NPI

Lewis County FPD 4

  • Land Ambulance
  • Morton, WA
National Provider Identifier
1154468627
Registry record updated Nov 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
21D04 Issued in WA
Legal business name
LEWIS COUNTY FPD 4
Practice address
105 Third St.
Morton, WA 98356
Phone
(360) 496-5183
NPI assigned
Jan 31, 2007
Last updated
Nov 9, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2012

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

Authorized official

Name
Michelle L Harbaugh
Title
EMS Captain
Phone
(360) 496-1283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 21D04 WA Primary

Addresses

Primary practice location

105 Third St.
Morton, WA 98356

Mailing address

PO Box 3510
Silverdale, WA 98383-3510
Phone (360) 394-7030

Other names 1

  • Morton Ambulance Service Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090805000575 WA Part B Supplier - Ambulance Service Supplier 7719030980 Practice locations: Morton, WA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352419200000",
    "number": "1154468627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3510",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983833510",
            "telephone_number": "360-394-7030",
            "fax_number": "360-394-7097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 THIRD ST.",
            "city": "MORTON",
            "state": "WA",
            "postal_code": "98356",
            "telephone_number": "360-496-5183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWIS COUNTY FPD 4",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2012-11-09",
        "status": "A",
        "authorized_official_last_name": "HARBAUGH",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EMS CAPTAIN",
        "authorized_official_telephone_number": "360-496-1283"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WA",
            "license": "21D04",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Morton Ambulance Service",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Morton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; 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.