1609890003 NPI number — WILLAMETTE VALLEY TRANSPORT, INC

Table of content: RACHEL MARIE JUDE EYMA MD (NPI 1720030653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609890003 NPI number — WILLAMETTE VALLEY TRANSPORT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLAMETTE VALLEY TRANSPORT, 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:
Provider Other Organization Name Type Code:
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:
1609890003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1440 13TH ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97302-2514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-569-7070
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10320 SE HWY 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015-9730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-939-4050
Provider Business Practice Location Address Fax Number:
503-939-4050
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCLAIN
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-569-5944

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 343900000X , 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: 233330 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com