Provider Demographics
NPI:1811036577
Name:SECURE TRANSPORTATION OF OREGON LLC
Entity type:Organization
Organization Name:SECURE TRANSPORTATION OF OREGON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF TRANSPORTATION
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAEHNIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-325-2119
Mailing Address - Street 1:5729 MAIN ST # 247
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-5426
Mailing Address - Country:US
Mailing Address - Phone:541-325-2119
Mailing Address - Fax:541-306-4872
Practice Address - Street 1:5729 MAIN ST # 247
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-5426
Practice Address - Country:US
Practice Address - Phone:541-325-2119
Practice Address - Fax:541-306-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR269382343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269382Medicaid