Healthcare Provider Details

I. General information

NPI: 1285636464
Provider Name (Legal Business Name): MARION COUNTY FIRE DISTRICT NO 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CORDON RD NE
SALEM OR
97317-5203
US

IV. Provider business mailing address

PO BOX 3510
SILVERDALE WA
98383-3510
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-6526
  • Fax: 503-588-6537
Mailing address:
  • Phone: 360-394-7010
  • Fax: 360-394-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2410
License Number StateOR

VIII. Authorized Official

Name: KYLE MCMANN
Title or Position: DEPUTY FIRE CHIEF
Credential:
Phone: 503-588-6535