Provider Demographics
NPI:1578562112
Name:SOUTH LANE COUNTY FIRE AND RESCUE
Entity Type:Organization
Organization Name:SOUTH LANE COUNTY FIRE AND RESCUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:LEESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOERRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-942-4493
Mailing Address - Street 1:233 E HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2473
Mailing Address - Country:US
Mailing Address - Phone:541-942-4493
Mailing Address - Fax:541-942-3367
Practice Address - Street 1:233 E HARRISON AVE
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2473
Practice Address - Country:US
Practice Address - Phone:541-942-4493
Practice Address - Fax:541-942-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2002-063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR298510Medicaid
OR116086Medicare ID - Type UnspecifiedNORIDIAN MEDICARE
ORP00042693Medicare ID - Type UnspecifiedTRAVELERS RR MEDICARE