1033231709 NPI number — NORTHWEST WADE CORPORATION

Table of content: (NPI 1033231709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033231709 NPI number — NORTHWEST WADE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST WADE CORPORATION
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:
COMMUNITY AMBULANCE
Provider Other Organization Name Type Code:
3
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:
1033231709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16098
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-241-7283
Provider Business Mailing Address Fax Number:
503-246-2155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9807 SE ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-241-7283
Provider Business Practice Location Address Fax Number:
503-246-2155
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KAUBLE
Authorized Official First Name:
JUNITA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
GENERAL MANAGER AND EMERGENCY MEDIC
Authorized Official Telephone Number:
503-241-7283

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  383936 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 343900000X , with the licence number: 383936 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 149187 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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