Provider Demographics
NPI:1467879858
Name:TUALATIN VALLEY FIRE & RESCUE
Entity Type:Organization
Organization Name:TUALATIN VALLEY FIRE & RESCUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUYCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-649-8577
Mailing Address - Street 1:11945 SW 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9196
Mailing Address - Country:US
Mailing Address - Phone:503-649-8577
Mailing Address - Fax:503-649-5347
Practice Address - Street 1:11945 SW 70TH AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-9196
Practice Address - Country:US
Practice Address - Phone:503-649-8577
Practice Address - Fax:503-649-5347
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUALATIN VALLEY FIRE & RESCUE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR34023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORE247005OtherAMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM
ORE247641OtherAMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM
OR3402OtherDEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM
ORE247006OtherAMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM
ORE247619OtherAMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM