Provider Demographics
NPI:1235132689
Name:CITY OF DALLAS
Entity Type:Organization
Organization Name:CITY OF DALLAS
Other - Org Name:CITY OF DALLAS AMBULANCE SVC
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-831-3537
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:360-394-7010
Mailing Address - Fax:360-394-7099
Practice Address - Street 1:187 SE COURT ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-3117
Practice Address - Country:US
Practice Address - Phone:503-831-3533
Practice Address - Fax:503-623-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2701-053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR045153Medicaid
OR756590275OtherRAILROAD MEDICARE PIN
OR756590275OtherRAILROAD MEDICARE PIN