Healthcare Provider Details

I. General information

NPI: 1861587578
Provider Name (Legal Business Name): CROOKED RIVER RANCH FIRE PROTECTION DISTRICT VI-503
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6971 SW SHAD RD
TERREBONNE OR
97760-7792
US

IV. Provider business mailing address

6971 SW SHAD RD
TERREBONNE OR
97760-7792
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-6776
  • Fax: 541-923-5247
Mailing address:
  • Phone: 541-923-6776
  • Fax: 541-923-5247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1613-06
License Number StateOR

VIII. Authorized Official

Name: MR. MARK W WILSON
Title or Position: FIRE CHIEF
Credential:
Phone: 541-923-6776