Provider Demographics
NPI:1215606132
Name:CONFEDERATED TRIBES OF THE GRAND RONDE COMMUNITY OF OREGON
Entity Type:Organization
Organization Name:CONFEDERATED TRIBES OF THE GRAND RONDE COMMUNITY OF OREGON
Other - Org Name:GRAND RONDE EMERGENCY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:QUALITY ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:TAUNI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-879-2060
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3510
Mailing Address - Country:US
Mailing Address - Phone:360-394-7020
Mailing Address - Fax:
Practice Address - Street 1:28480 MCPHERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND RONDE
Practice Address - State:OR
Practice Address - Zip Code:97347-9708
Practice Address - Country:US
Practice Address - Phone:503-879-1838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport