Provider Demographics
NPI:1114305166
Name:PROTECH AUTOMOTIVE INC
Entity Type:Organization
Organization Name:PROTECH AUTOMOTIVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUDENMIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-334-6738
Mailing Address - Street 1:10883 SE MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7641
Mailing Address - Country:US
Mailing Address - Phone:503-334-4638
Mailing Address - Fax:888-834-1688
Practice Address - Street 1:10883 SE MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7641
Practice Address - Country:US
Practice Address - Phone:503-334-4638
Practice Address - Fax:888-834-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR917 GWN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)