1629716303 NPI number — PACIFIC NORTHWEST MEDICAL TRANSPORT SERVICE, INC

Table of content: DR. TYLER ASPINWALL CLARK M.D. (NPI 1447549183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629716303 NPI number — PACIFIC NORTHWEST MEDICAL TRANSPORT SERVICE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC NORTHWEST MEDICAL TRANSPORT SERVICE, 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:
1629716303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6053
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:
97304-0257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-798-1824
Provider Business Mailing Address Fax Number:
503-385-1300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2752 HOOVER AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97304-3780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-789-1824
Provider Business Practice Location Address Fax Number:
503-385-1300
Provider Enumeration Date:
05/23/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PHILL
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
TYLER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-798-1824

Provider Taxonomy Codes

  • Taxonomy code: 347C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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