Healthcare Provider Details

I. General information

NPI: 1609890003
Provider Name (Legal Business Name): WILLAMETTE VALLEY TRANSPORT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10320 SE HWY 212
CLACKAMAS OR
97015-9730
US

IV. Provider business mailing address

1440 13TH ST SE
SALEM OR
97302-2514
US

V. Phone/Fax

Practice location:
  • Phone: 503-939-4050
  • Fax: 503-939-4050
Mailing address:
  • Phone: 503-569-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateOR

VIII. Authorized Official

Name: TIMOTHY F MCCLAIN
Title or Position: PRESIDENT
Credential:
Phone: 503-569-5944