# SOUTHERN WASCO COUNTY AMBULANCE SERVICE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376625319
- **Authorized official:** VIRGINIA ANN FULLER (SECRETARY)
- **Authorized official phone:** (541) 395-2598

## Contact information

- **Practice address:** 390 3RD ST, MAUPIN, OR 97037-9246
- **Practice address phone:** (541) 395-2598
- **Mailing address:** PO BOX 3510, SILVERDALE, WA 98383-3510
- **Mailing address phone:** (360) 394-7030
- **Mailing address fax:** (360) 394-7094

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 3303-04 | OR | Yes |

## Other

- **Enumeration date:** 10/19/2006
- **Last updated:** 02/16/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 179119 | — | OR |
| 05 | — | 9032186 | — | WA |