1750372553 NPI number — WESTERN LANE AMBULANCE DISTRICT

Table of content: (NPI 1750372553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750372553 NPI number — WESTERN LANE AMBULANCE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN LANE AMBULANCE DISTRICT
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:
1750372553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 9TH ST
Provider Second Line Business Mailing Address:
P.O. BOX 2690
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97439-7398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-997-9614
Provider Business Mailing Address Fax Number:
541-997-2995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97439-7398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-997-9614
Provider Business Practice Location Address Fax Number:
541-997-2995
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HANF
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
Authorized Official Title or Position:
DISTRICT MANAGER
Authorized Official Telephone Number:
541-997-9614

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2003-05 , 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: 209536 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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