Provider Demographics
NPI:1700975638
Name:WOODBURN AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:WOODBURN AMBULANCE SERVICE, INC.
Other - Org Name:MT ANGEL AMBULANCE , SILVERTON AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-982-4699
Mailing Address - Street 1:PO BOX 584
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-0584
Mailing Address - Country:US
Mailing Address - Phone:503-982-4699
Mailing Address - Fax:503-982-4823
Practice Address - Street 1:1040 N BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-0584
Practice Address - Country:US
Practice Address - Phone:503-982-4699
Practice Address - Fax:503-982-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR161422Medicaid
OR0000RGBJDMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER