MEDICARE: SOUTH LANE COUNTY FIRE AND RESCUE

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	2002-06	OR

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	:	1578562112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH LANE COUNTY FIRE AND RESCUE

Provider Business Mailing Address
First Line	:	233 E HARRISON AVE
Second Line	:
City	:	COTTAGE GROVE
State	:	OR
Zip	:	97424-2473
Country	:	US
Telephone Number	:	541-942-4493
Fax Number	:	541-942-3367

Provider Business Practice Location Address
First Line	:	233 E HARRISON AVE
Second Line	:
City	:	COTTAGE GROVE
State	:	OR
Zip	:	97424-2473
Country	:	US
Telephone Number	:	541-942-4493
Fax Number	:	541-942-3367

Authorized Official
Title or Position	:	AMBULANCE BILLING CLERK
Name	:	LEESA DOERRIE
Credential	:
Telephone Number	:	541-942-4493

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	08/03/2021

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Directions to “SOUTH LANE COUNTY FIRE AND RESCUE ” Practice Location

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