MEDICARE: CITY OF DALLAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	2701-05	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	756590275	OTHER	OR	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235132689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF DALLAS

Provider Business Mailing Address
First Line	:	PO BOX 3510
Second Line	:
City	:	SILVERDALE
State	:	WA
Zip	:	98383-3510
Country	:	US
Telephone Number	:	360-394-7010
Fax Number	:	360-394-7099

Provider Business Practice Location Address
First Line	:	187 SE COURT ST
Second Line	:
City	:	DALLAS
State	:	OR
Zip	:	97338-3117
Country	:	US
Telephone Number	:	503-831-3533
Fax Number	:	503-623-7352

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	MR. TODD BRUMFIELD
Credential	:
Telephone Number	:	503-831-3537

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	11/07/2016

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Directions to “CITY OF DALLAS ” Practice Location

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