Provider Demographics
NPI:1093738080
Name:CITY OF SUTHERLIN
Entity Type:Organization
Organization Name:CITY OF SUTHERLIN
Other - Org Name:CITY OF SUTHERLIN
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-459-1394
Mailing Address - Street 1:126 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479
Mailing Address - Country:US
Mailing Address - Phone:541-459-1394
Mailing Address - Fax:541-459-1693
Practice Address - Street 1:250 S STATE ST
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479
Practice Address - Country:US
Practice Address - Phone:541-459-1394
Practice Address - Fax:541-459-1693
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF SUTHERLIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1041063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
590009447OtherRAILROAD MEDICARE
R0000RGCMSMedicare ID - Type Unspecified
W81000Medicare UPIN