Organization
PACIFIC WEST AMBULANCE INC
Active
Other names
Lincoln City Ambulance
Organization subpart
No
Provider details
NPI number
Authorized official
J D FUITEN (OWNER)
(541) 648-6658
Entity
Organization
Contact information
Practice address
609 NW COAST ST, NEWPORT, OR 97365
(541) 265-3175
(541) 574-5209
Mailing address
609 NW COAST ST, NEWPORT, OR 97365-3409
(541) 265-3175
(541) 574-5209
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
2102
OR
343900000X
Non-emergency Medical Transport (VAN)
2102
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0152169
—
OH
01
—
037140000
BLUE CROSS OUT OF STATE
—
01
—
0443326
CONSULTEC INC
—
01
—
080835000
BLUE CROSS OF OREGON
OR
05
—
100502357
—
NV
01
—
107959
WASHINGTON DEPT LABOR
—
01
—
154682
OREGON HEALTH PLAN
OR
05
—
154682
—
OR
01
—
233331
OMAP
OR
01
—
519374
ODS HEALTH PLAN
—
01
—
590004562
RAILROAD MEDICARE
—
01
—
806591000
IDAHO EDS
ID
01
—
9029034
WA DEPT SOCIAL & HLTH SVC
WA
05
—
9029034
—
WA
05
—
916801
—
AZ
05
—
96000625
—
CO
05
—
N266969
—
FL
05
—
XMTE06451
—
CA
Enumeration date
09/26/2006
Last updated
09/02/2015
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