Provider Demographics
NPI:1003960212
Name:CITY OF MCMINNVILLE
Entity type:Organization
Organization Name:CITY OF MCMINNVILLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-435-5800
Mailing Address - Street 1:175 NE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6048
Mailing Address - Country:US
Mailing Address - Phone:503-435-5806
Mailing Address - Fax:503-435-5815
Practice Address - Street 1:175 NE 1ST ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6048
Practice Address - Country:US
Practice Address - Phone:503-435-5806
Practice Address - Fax:503-435-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR36033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR117788Medicaid
ORR0000RGBFFMedicare ID - Type Unspecified