1437179033 NPI number — COUNTY OF SHERMAN

Table of content: (NPI 1437179033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437179033 NPI number — COUNTY OF SHERMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SHERMAN
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:
6
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:
1437179033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 DEWEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-565-3100
Provider Business Mailing Address Fax Number:
541-565-3024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 DEWEY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-565-3100
Provider Business Practice Location Address Fax Number:
541-565-3024
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAYNE
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
EMT2
Authorized Official Telephone Number:
541-565-3100

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2801-01 , 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: 9041393 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 178566 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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