Provider Demographics
NPI:1164508347
Name:LINN-BENTON-LINCOLN EDUCATION SERVICE DISTRICT
Entity Type:Organization
Organization Name:LINN-BENTON-LINCOLN EDUCATION SERVICE DISTRICT
Other - Org Name:DR. LARRY MARTIN
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-812-2600
Mailing Address - Street 1:905 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3104
Mailing Address - Country:US
Mailing Address - Phone:541-812-2600
Mailing Address - Fax:
Practice Address - Street 1:905 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3104
Practice Address - Country:US
Practice Address - Phone:541-812-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR003785Medicaid