Interlocal Organization of LC Rural

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

21D02 Issued in WA

Legal business name

INTERLOCAL ORGANIZATION OF LC RURAL

Practice address

150 N 2ND St
Toledo, WA 98591

Phone

(360) 864-2366

NPI assigned

Apr 17, 2006

Organization subpart

No

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

Authorized official

Name

Grant Wiltbank

Title

Fire Chief

Phone

(360) 864-2366

Specialties & licenses 1

Addresses

Other identifiers 4

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

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305504000000",
    "number": "1689638553",
    "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": "150 N 2ND ST",
            "city": "TOLEDO",
            "state": "WA",
            "postal_code": "98591",
            "telephone_number": "360-864-2366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERLOCAL ORGANIZATION OF LC RURAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-17",
        "last_updated": "2011-05-16",
        "status": "A",
        "authorized_official_last_name": "WILTBANK",
        "authorized_official_first_name": "GRANT",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "360-864-2366"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WA",
            "license": "21D02",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I AND CRIME VICTIMS",
            "identifier": "0235205",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9038480",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "IN9964",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182534",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.