1033112594 NPI number — CITY OF SALEM

Table of content: (NPI 1033112594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033112594 NPI number — CITY OF SALEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SALEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SALEM AREA MEDICAL TRANSPORT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033112594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2742 25TH ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97302-1108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-588-6271
Provider Business Mailing Address Fax Number:
503-588-6202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2742 25TH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97302-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-588-6271
Provider Business Practice Location Address Fax Number:
503-588-6202
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NIBLOCK
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM FIRE CHIEF
Authorized Official Telephone Number:
503-588-6245

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  241105 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 590009956 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 170191 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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