Provider Demographics
NPI:1902921653
Name:CITY/BOROUGH OF WRANGELL
Entity Type:Organization
Organization Name:CITY/BOROUGH OF WRANGELL
Other - Org Name:WRANGELL AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE DEPARTMENT CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUNESS
Authorized Official - Suffix:
Authorized Official - Credentials:FIRE DEPT CHIEF
Authorized Official - Phone:907-874-3223
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:WRANGELL
Mailing Address - State:AK
Mailing Address - Zip Code:99929-0794
Mailing Address - Country:US
Mailing Address - Phone:907-874-3223
Mailing Address - Fax:907-874-3939
Practice Address - Street 1:431 ZIMOVIA HWY
Practice Address - Street 2:
Practice Address - City:WRANGELL
Practice Address - State:AK
Practice Address - Zip Code:99929-0794
Practice Address - Country:US
Practice Address - Phone:907-874-3223
Practice Address - Fax:907-874-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK04153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGA0144Medicaid
AKGA0144Medicaid