Provider Demographics
NPI:1629165865
Name:CITY OF LA GRANDE
Entity Type:Organization
Organization Name:CITY OF LA GRANDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-963-3123
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-3517
Mailing Address - Country:US
Mailing Address - Phone:541-963-3123
Mailing Address - Fax:541-963-2192
Practice Address - Street 1:1806 COVE AVENUE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-3517
Practice Address - Country:US
Practice Address - Phone:541-963-3123
Practice Address - Fax:541-963-2192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR31033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230921Medicaid
ORR112518Medicare PIN