Provider Demographics
NPI:1497858773
Name:PINE EAGLE HEALTH PLANNING COMMITTEE
Entity Type:Organization
Organization Name:PINE EAGLE HEALTH PLANNING COMMITTEE
Other - Org Name:VFW HALFWAY OXOBW AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-742-5024
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:223 CENTER STREET
Mailing Address - City:HALFWAY
Mailing Address - State:OR
Mailing Address - Zip Code:97834-0488
Mailing Address - Country:US
Mailing Address - Phone:541-742-7425
Mailing Address - Fax:541-742-7425
Practice Address - Street 1:223 CENTER STREET
Practice Address - Street 2:
Practice Address - City:HALFWAY
Practice Address - State:OR
Practice Address - Zip Code:97834
Practice Address - Country:US
Practice Address - Phone:541-742-7425
Practice Address - Fax:541-742-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR01053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR085944Medicaid
OR134596Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER