Provider Demographics
NPI:1023182417
Name:CITY OF CORVALLIS
Entity Type:Organization
Organization Name:CITY OF CORVALLIS
Other - Org Name:CITY OF CORVALLIS - AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WRIGHTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-766-6990
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1083
Mailing Address - Country:US
Mailing Address - Phone:541-766-6996
Mailing Address - Fax:541-754-1729
Practice Address - Street 1:400 NW HARRISON BLVD
Practice Address - Street 2:MAIN FIRE STATION
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-766-6961
Practice Address - Fax:541-766-6938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR020106341600000X
OR05270500241671200341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR033605Medicaid
OR033605Medicaid