Provider Demographics
NPI:1891747242
Name:CITY OF NEWBERG
Entity Type:Organization
Organization Name:CITY OF NEWBERG
Other - Org Name:CITY OF NEWBERG AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:CITY MANGAER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:DANICIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-537-1207
Mailing Address - Street 1:414 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3006
Mailing Address - Country:US
Mailing Address - Phone:503-537-1230
Mailing Address - Fax:
Practice Address - Street 1:414 E 2ND ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3006
Practice Address - Country:US
Practice Address - Phone:503-537-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3605-063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR128723Medicaid
040097000OtherBLUE CROSS/BLUE SHIELD
590015410OtherPALMETTO GBA
ORR142059OtherMEDICARE ID
OR128723Medicaid