NPIMap

Organization Active NPI

Klickitat County Emergency Medical Services No 1

  • Land Ambulance
  • Goldendale, WA
National Provider Identifier
1366873044
Registry record updated May 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
Legal business name
KLICKITAT COUNTY EMERGENCY MEDICAL SERVICES NO 1
Practice address
310 S Roosevelt Ave
Goldendale, WA 98620-9201
Phone
(509) 773-4022
Fax
(509) 773-1941
NPI assigned
Dec 6, 2013
Last updated
May 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2023

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

Authorized official

Name
William Earl Harryman
Title
Chief of EMS Operations
Phone
(509) 767-7054

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X Primary

Addresses

Primary practice location

310 S Roosevelt Ave
Goldendale, WA 98620-9201

Mailing address

PO Box 455
Dallesport, WA 98617-0455
Phone (509) 773-4022

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140529002492 WA Part B Supplier - Ambulance Service Supplier 3577786086 Practice locations: Dallesport, WA; Goldendale, WA; White Salmon, 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": "1386288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685059200000",
    "number": "1366873044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 455",
            "city": "DALLESPORT",
            "state": "WA",
            "postal_code": "986170455",
            "telephone_number": "509-773-4022",
            "fax_number": "509-773-1941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S ROOSEVELT AVE",
            "city": "GOLDENDALE",
            "state": "WA",
            "postal_code": "986209201",
            "telephone_number": "509-773-4022",
            "fax_number": "509-773-1941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KLICKITAT COUNTY EMERGENCY MEDICAL SERVICES NO 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-06",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A",
        "authorized_official_last_name": "HARRYMAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "CHIEF OF EMS OPERATIONS",
        "authorized_official_telephone_number": "509-767-7054"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldendale, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2023; 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.