1750652673 NPI number — TUALATIN VALLEY FIRE & RESCUE

Table of content: (NPI 1750652673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750652673 NPI number — TUALATIN VALLEY FIRE & RESCUE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TUALATIN VALLEY FIRE & RESCUE
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:
1750652673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11945 SW 70TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIGARD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97223-9196
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-649-8577
Provider Business Mailing Address Fax Number:
503-649-5347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11945 SW 70TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIGARD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97223-9196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-259-1129
Provider Business Practice Location Address Fax Number:
503-259-1129
Provider Enumeration Date:
01/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WEISS
Authorized Official First Name:
DERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
503-259-1129

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3402 , 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: E247641 . This is a "AMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: E247005 . This is a "AMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: E247006 . This is a "AMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: E247619 . This is a "AMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 3402 . This is a "DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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