Provider Demographics
NPI:1902339849
Name:PEND OREILLE PARAMEDICS
Entity Type:Organization
Organization Name:PEND OREILLE PARAMEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-671-6699
Mailing Address - Street 1:PO BOX 1942
Mailing Address - Street 2:137 S NEWPORT AVE
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-1942
Mailing Address - Country:US
Mailing Address - Phone:509-447-1202
Mailing Address - Fax:509-447-1201
Practice Address - Street 1:137 S NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-1942
Practice Address - Country:US
Practice Address - Phone:509-447-1200
Practice Address - Fax:509-447-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6040906523416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2089321Medicaid