Provider Demographics
NPI:1558442798
Name:CITY OF CASCADE LOCKS
Entity Type:Organization
Organization Name:CITY OF CASCADE LOCKS
Other - Org Name:CASCADE LOCKS AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF/ EMT-I
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-374-8510
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:CASCADE LOCKS
Mailing Address - State:OR
Mailing Address - Zip Code:97014-0308
Mailing Address - Country:US
Mailing Address - Phone:541-374-8510
Mailing Address - Fax:541-374-8152
Practice Address - Street 1:140 WA-NA-PA ST.
Practice Address - Street 2:
Practice Address - City:CASCADE LOCKS
Practice Address - State:OR
Practice Address - Zip Code:97014
Practice Address - Country:US
Practice Address - Phone:541-374-8510
Practice Address - Fax:541-374-8152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1401-063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
006050000OtherBLUE CROSS / BLUE SHIELD
590014058OtherPALMETTO GBA
OR027979Medicaid