Provider Demographics
NPI:1356446405
Name:MEDIX AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:MEDIX AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PHIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-861-5570
Mailing Address - Street 1:2325 SE DOLPHIN AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9570
Mailing Address - Country:US
Mailing Address - Phone:503-861-1990
Mailing Address - Fax:503-861-5555
Practice Address - Street 1:2325 SE DOLPHIN AVE
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-9570
Practice Address - Country:US
Practice Address - Phone:503-861-1990
Practice Address - Fax:503-861-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR001222Medicaid
ORR0000RGBNMMedicare ID - Type UnspecifiedPROVIDER NUMBER