Provider Demographics
NPI:1134255169
Name:GLENDALE AMBULANCE DISTRICT
Entity type:Organization
Organization Name:GLENDALE AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-832-2375
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:416 TUNNEL ROAD
Mailing Address - City:GLENDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97442-9707
Mailing Address - Country:US
Mailing Address - Phone:541-832-2900
Mailing Address - Fax:541-832-2471
Practice Address - Street 1:416 TUNNEL ROAD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:OR
Practice Address - Zip Code:97442-0495
Practice Address - Country:US
Practice Address - Phone:541-832-2900
Practice Address - Fax:541-832-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1007341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR018916Medicaid
OR018916OtherOMAP
OR018916Medicaid