Provider Demographics
NPI:1376620799
Name:POLK COUNTY FIRE DISTRICT NO.1
Entity Type:Organization
Organization Name:POLK COUNTY FIRE DISTRICT NO.1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFIE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-838-1510
Mailing Address - Street 1:1800 MONMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-9700
Mailing Address - Country:US
Mailing Address - Phone:503-838-1510
Mailing Address - Fax:503-838-1235
Practice Address - Street 1:1800 MONMOUTH ST
Practice Address - Street 2:NOT APPLICABLE
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-9700
Practice Address - Country:US
Practice Address - Phone:503-838-1510
Practice Address - Fax:503-838-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2703-063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR119461Medicaid
OR119461Medicaid