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General NPI Number Information
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NPI Number | 1467505883
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Entity Type | Organization
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Legal Business Name | SOUTH GILLIAM COUNTY AMBULANCE
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 422 N MAIN
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City | CONDON
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State | OR
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Zip | 97823-0085
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Country | US
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Telephone | 541-384-2061
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 85
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City | CONDON
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State | OR
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Zip | 97823-0085
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INSURANCE CLERK
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Name | CINDY HESS
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Credential |
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Telephone | 541-384-2061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1104
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License Number State | OR
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