Provider Demographics
NPI:1689952384
Name:CITY OF FOREST GROVE ATTN:PAYROLL CLERK
Entity Type:Organization
Organization Name:CITY OF FOREST GROVE ATTN:PAYROLL CLERK
Other - Org Name:FOREST GROVE FIRE AND RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KINKADE
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:503-992-3240
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-0326
Mailing Address - Country:US
Mailing Address - Phone:503-992-3240
Mailing Address - Fax:503-992-3243
Practice Address - Street 1:1919 ASH ST
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2426
Practice Address - Country:US
Practice Address - Phone:503-992-3240
Practice Address - Fax:503-992-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORE2297543416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport