Provider Demographics
NPI:1295869584
Name:PORT ORFORD COMMUNITY AMBULANCE INC
Entity type:Organization
Organization Name:PORT ORFORD COMMUNITY AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHDOWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-332-0384
Mailing Address - Street 1:PO BOX 582
Mailing Address - Street 2:
Mailing Address - City:PORT ORFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97465-0582
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:552 19TH ST
Practice Address - Street 2:
Practice Address - City:PORT ORFORD
Practice Address - State:OR
Practice Address - Zip Code:97465
Practice Address - Country:US
Practice Address - Phone:541-332-0384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR148916Medicaid
ORR0000RGBGGMedicare PIN