Provider Demographics
NPI:1770652737
Name:CITY OF COQUILLE
Entity Type:Organization
Organization Name:CITY OF COQUILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WADDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-396-2232
Mailing Address - Street 1:89 W 3RD ST
Mailing Address - Street 2:P.O. BOX 263
Mailing Address - City:COQUILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97423-1266
Mailing Address - Country:US
Mailing Address - Phone:541-396-2232
Mailing Address - Fax:541-824-0129
Practice Address - Street 1:89 W 3RD ST
Practice Address - Street 2:
Practice Address - City:COQUILLE
Practice Address - State:OR
Practice Address - Zip Code:97423-1266
Practice Address - Country:US
Practice Address - Phone:541-396-2232
Practice Address - Fax:541-824-0129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR029090Medicaid
ORR0000RGBRFMedicare ID - Type UnspecifiedAMBULANCE