Organization
GROOM ENTERPRISES
Active
Other names
Newport Ambulance
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN C GROOM (PRESIDENT)
(509) 447-4108
Entity
Organization
Contact information
Practice address
117 S WASHINGTON AVE, NEWPORT, WA 99156-9665
(509) 447-4108
Mailing address
PO BOX 298, NEWPORT, WA 99156-0298
(509) 447-4108
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
26X02
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00001004260
BLUE SHIELD IDAHO
ID
01
—
00393077
WASHINGTON L&I
WA
05
—
804257500
—
ID
05
—
9120502
—
WA
01
—
BMKM0
BLUE CROSS IDAHO
ID
Enumeration date
11/27/2006
Last updated
03/09/2010
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