Provider Demographics
NPI:1710178686
Name:EAGLEVALLEY AMBULANCE
Entity Type:Organization
Organization Name:EAGLEVALLEY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-403-2604
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97870
Mailing Address - Country:US
Mailing Address - Phone:541-403-2604
Mailing Address - Fax:541-523-0370
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:OR
Practice Address - Zip Code:97870-5000
Practice Address - Country:US
Practice Address - Phone:541-403-2604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR222216Medicaid
OR222216Medicaid