Provider Demographics
NPI:1437179033
Name:COUNTY OF SHERMAN
Entity Type:Organization
Organization Name:COUNTY OF SHERMAN
Other - Org Name:SHERMAN COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMT2
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-565-3100
Mailing Address - Street 1:309 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:MORO
Mailing Address - State:OR
Mailing Address - Zip Code:97039
Mailing Address - Country:US
Mailing Address - Phone:541-565-3100
Mailing Address - Fax:541-565-3024
Practice Address - Street 1:309 DEWEY STREET
Practice Address - Street 2:
Practice Address - City:MORO
Practice Address - State:OR
Practice Address - Zip Code:97039
Practice Address - Country:US
Practice Address - Phone:541-565-3100
Practice Address - Fax:541-565-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2801-013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9041393Medicaid
OR178566Medicaid
WA9041393Medicaid
ORR0000RGBGQMedicare ID - Type Unspecified