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General NPI Number Information
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NPI Number | 1497858773
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Entity Type | Organization
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Legal Business Name | PINE EAGLE HEALTH PLANNING COMMITTEE
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 223 CENTER STREET
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City | HALFWAY
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State | OR
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Zip | 97834
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Country | US
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Telephone | 541-742-7425
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Fax | 541-742-7425
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Provider Business Mailing Address
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Address Line | PO BOX 488 223 CENTER STREET
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City | HALFWAY
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State | OR
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Zip | 97834-0488
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Country | US
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Telephone | 541-742-7425
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Fax | 541-742-7425
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TERRA LEWIS
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Credential |
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Telephone | 541-742-5024
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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 | 0105
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License Number State | OR
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