Provider Demographics
NPI:1518062264
Name:CITY OF ALBANY
Entity Type:Organization
Organization Name:CITY OF ALBANY
Other - Org Name:ALBANY FIRE DEPARTMENT AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WES
Authorized Official - Middle Name:
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-917-7505
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-0144
Mailing Address - Country:US
Mailing Address - Phone:541-917-7710
Mailing Address - Fax:541-917-7540
Practice Address - Street 1:333 BROADALBIN STREET SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-0144
Practice Address - Country:US
Practice Address - Phone:541-917-7710
Practice Address - Fax:541-917-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2201341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
38D0685979OtherCMS CLIA
OR028829Medicaid
ORR0000RGBJSMedicare PIN