=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811072432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONFEDERATED TRIBES OF THE UMATILLA INDIAN RESERVATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 12/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 73382 CONFEDERATED WAY
-----------------------------------------------------
City | PENDLETON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-278-7676
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46411 TIMINE WAY
-----------------------------------------------------
City | PENDLETON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97801-9467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-278-7676
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | JAMES HALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-276-2126
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 303306
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------