Provider Demographics
NPI:1760416358
Name:CITY OF BEND
Entity Type:Organization
Organization Name:CITY OF BEND
Other - Org Name:CITY OF BEND AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-322-6387
Mailing Address - Street 1:PO BOX 1024
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-1024
Mailing Address - Country:US
Mailing Address - Phone:541-322-6318
Mailing Address - Fax:541-385-6675
Practice Address - Street 1:710 NW WALL ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2713
Practice Address - Country:US
Practice Address - Phone:541-322-6318
Practice Address - Fax:541-693-2166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF BEND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09013416L0300X, 343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR121202Medicaid
OR121202Medicaid