Provider Demographics
NPI:1952595522
Name:JORDAN VALLEY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:JORDAN VALLEY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-586-2799
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:JORDAN VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97910-0345
Mailing Address - Country:US
Mailing Address - Phone:541-586-2449
Mailing Address - Fax:541-586-2449
Practice Address - Street 1:306 BLACKABY ST
Practice Address - Street 2:
Practice Address - City:JORDAN VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97910
Practice Address - Country:US
Practice Address - Phone:541-586-2449
Practice Address - Fax:541-586-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2301-06341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000RGBJTMedicare PIN