Healthcare Provider Details

I. General information

NPI: 1538495213
Provider Name (Legal Business Name): WILLAMETTE VALLEY MEDICAL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RATCLIFF DR SE
SALEM OR
97302-3236
US

IV. Provider business mailing address

725 RATCLIFF DR SE
SALEM OR
97302-3236
US

V. Phone/Fax

Practice location:
  • Phone: 503-569-7070
  • Fax: 877-560-8416
Mailing address:
  • Phone: 503-569-7070
  • Fax: 877-560-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY MCCLAIN
Title or Position: PRESIDENT
Credential:
Phone: 503-569-7070