Provider Demographics
NPI:1275542524
Name:CITY OF MYRTLE POINT
Entity Type:Organization
Organization Name:CITY OF MYRTLE POINT
Other - Org Name:MYRTLE POINT AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-572-2993
Mailing Address - Street 1:424 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97458-1114
Mailing Address - Country:US
Mailing Address - Phone:541-572-2993
Mailing Address - Fax:
Practice Address - Street 1:320 5TH STREET
Practice Address - Street 2:
Practice Address - City:MYRTLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97458-1039
Practice Address - Country:US
Practice Address - Phone:541-572-2993
Practice Address - Fax:541-572-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0602341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR024992Medicaid
ORR0000RGBJMMedicare ID - Type UnspecifiedAMBULANCE