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General NPI Number Information
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NPI Number | 1689952384
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Entity Type | Organization
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Legal Business Name | CITY OF FOREST GROVE ATTN:PAYROLL CLERK
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Dates
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Enumeration Date | 07/28/2011
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Last Update Date | 04/04/2013
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Provider Practice Location Address
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Address Line | 1919 ASH ST
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City | FOREST GROVE
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State | OR
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Zip | 97116-2426
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Country | US
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Telephone | 503-992-3240
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Fax | 503-992-3243
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Provider Business Mailing Address
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Address Line | PO BOX 326
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City | FOREST GROVE
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State | OR
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Zip | 97116-0326
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Country | US
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Telephone | 503-992-3240
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Fax | 503-992-3243
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Authorized Official
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Title or Position | FIRE CHIEF
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Name | MICHAEL KINKADE
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Credential | PARAMEDIC
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Telephone | 503-992-3240
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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 | E229754
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License Number State | OR
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