Lewis County FPD 4
Organization Active NPI Land Ambulance · Morton, WA
NPI 1154468627 · NPPES record last updated Nov 9, 2012
Key facts
- NPI
- 1154468627
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 21D04 (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
- Organization subpart
- No
Authorized official
- Name
- Michelle L Harbaugh
- Title
- EMS Captain
- Phone
- (360) 496-1283
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090805000575 | WA | Part B Supplier - Ambulance Service Supplier | 7719030980 | Practice locations: Morton, WA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 21D04 | WA | Yes |
Addresses
Primary practice location
105 Third St.
Morton, WA 98356
Mailing address
PO Box 3510
Silverdale, WA 98383-3510
Phone (360) 394-7030
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 616061100 | Other | WA | OWCP |
| 0250091 | Other | WA | L&I AND CRIME VICTIMS |
| 9021882 | Medicaid | WA |
Other names
- Morton Ambulance Service
Other providers in Morton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.