Healthcare Provider Details

I. General information

NPI: 1326219171
Provider Name (Legal Business Name): CITY OF FOSSIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MAIN STREET
FOSSIL OR
97830
US

IV. Provider business mailing address

PO BOX 467
FOSSIL OR
97830-0467
US

V. Phone/Fax

Practice location:
  • Phone: 541-763-2698
  • Fax: 541-763-2124
Mailing address:
  • Phone: 541-763-2698
  • Fax: 541-763-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number3501
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0000RGBDD
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerMEDICARE PIN

VIII. Authorized Official

Name: MS. TERESA GWENDOLYN HUNT
Title or Position: CITY RECORDER
Credential:
Phone: 541-763-2698