Healthcare Provider Details

I. General information

NPI: 1578562112
Provider Name (Legal Business Name): SOUTH LANE COUNTY FIRE AND RESCUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 08/03/2021
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E HARRISON AVE
COTTAGE GROVE OR
97424-2473
US

IV. Provider business mailing address

233 E HARRISON AVE
COTTAGE GROVE OR
97424-2473
US

V. Phone/Fax

Practice location:
  • Phone: 541-942-4493
  • Fax: 541-942-3367
Mailing address:
  • Phone: 541-942-4493
  • Fax: 541-942-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2002-06
License Number StateOR

VIII. Authorized Official

Name: LEESA DOERRIE
Title or Position: AMBULANCE BILLING CLERK
Credential:
Phone: 541-942-4493