1811999535 NPI number — SOUTH LINCOLN AMBULANCE INC.

Table of content: (NPI 1811999535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811999535 NPI number — SOUTH LINCOLN AMBULANCE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH LINCOLN AMBULANCE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTH LINCOLN AMBULANCE ASSOCIATION
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811999535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YACHATS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97498-0031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-547-3766
Provider Business Mailing Address Fax Number:
541-547-4257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 W 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YACHATS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-547-3266
Provider Business Practice Location Address Fax Number:
541-547-4257
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PETRICK
Authorized Official First Name:
FRANCES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
AMBULANCE CHIEF
Authorized Official Telephone Number:
541-547-3266

Provider Taxonomy Codes

  • Taxonomy code: 146L00000X , with the licence number:  2112-06 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 006352000 . This is a "BCBS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 189407 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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