Provider Demographics
NPI:1134167661
Name:CITY OF OAKRIDGE
Entity type:Organization
Organization Name:CITY OF OAKRIDGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-782-2258
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:OAKRIDGE
Mailing Address - State:OR
Mailing Address - Zip Code:97463-1410
Mailing Address - Country:US
Mailing Address - Phone:541-782-2416
Mailing Address - Fax:541-782-2414
Practice Address - Street 1:47592 HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:OAKRIDGE
Practice Address - State:OR
Practice Address - Zip Code:97463-9740
Practice Address - Country:US
Practice Address - Phone:541-782-2416
Practice Address - Fax:541-782-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR341610300X3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
006067000OtherBLUE CROSS/BLUE SHIELD
590001977OtherPALMETTO GBA
OR143784Medicaid
ORR0000RGBFTMedicare ID - Type Unspecified