Provider Demographics
NPI:1073672747
Name:NORTH DOUGLAS COUNTY FIRE AND EMS
Entity Type:Organization
Organization Name:NORTH DOUGLAS COUNTY FIRE AND EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-836-2282
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:DRAIN
Mailing Address - State:OR
Mailing Address - Zip Code:97435-0277
Mailing Address - Country:US
Mailing Address - Phone:541-836-2282
Mailing Address - Fax:541-836-2292
Practice Address - Street 1:531 S CEDAR ST.
Practice Address - Street 2:
Practice Address - City:DRAIN
Practice Address - State:OR
Practice Address - Zip Code:97435
Practice Address - Country:US
Practice Address - Phone:541-836-2282
Practice Address - Fax:541-836-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0006-063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR135546Medicaid
OR013427000OtherBLUE CROSS BLUE SHIELD
OR590010959OtherPALMETTO GBA
ORR0000RGCNHMedicare ID - Type Unspecified