MEDICARE: GLENDALE VOLUNTEER AMBULANCE DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	1007	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	018916	OTHER	OR	OMAP

General Provider Information

NPI Number	:	1134255169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENDALE VOLUNTEER AMBULANCE DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 495
Second Line	:
City	:	GLENDALE
State	:	OR
Zip	:	97442-0495
Country	:	US
Telephone Number	:	541-832-2900
Fax Number	:	541-832-2471

Provider Business Practice Location Address
First Line	:	416 TUNNEL ROAD
Second Line	:
City	:	GLENDALE
State	:	OR
Zip	:	97442-0495
Country	:	US
Telephone Number	:	541-832-2900
Fax Number	:	541-832-2471

Authorized Official
Title or Position	:	DISTRICT MANAGER
Name	:	CRAIG DARYLE BLETH
Credential	:
Telephone Number	:	541-944-5440

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	01/24/2026

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Directions to “GLENDALE VOLUNTEER AMBULANCE DISTRICT ” Practice Location

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