Provider Demographics
NPI:1538495213
Name:WILLAMETTE VALLEY MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:WILLAMETTE VALLEY MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-569-7070
Mailing Address - Street 1:725 RATCLIFF DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3236
Mailing Address - Country:US
Mailing Address - Phone:503-569-7070
Mailing Address - Fax:877-560-8416
Practice Address - Street 1:725 RATCLIFF DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3236
Practice Address - Country:US
Practice Address - Phone:503-569-7070
Practice Address - Fax:877-560-8416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR233330Medicaid