Provider Demographics
NPI:1154535946
Name:SUNRIVER SERVICE DISTRICT
Entity type:Organization
Organization Name:SUNRIVER SERVICE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROD
Authorized Official - Middle Name:
Authorized Official - Last Name:BJORVIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-593-8622
Mailing Address - Street 1:PO BOX 2108
Mailing Address - Street 2:
Mailing Address - City:SUNRIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97707-4108
Mailing Address - Country:US
Mailing Address - Phone:541-593-8622
Mailing Address - Fax:
Practice Address - Street 1:57475 ABBOT DR
Practice Address - Street 2:
Practice Address - City:SUNRIVER
Practice Address - State:OR
Practice Address - Zip Code:97707-4108
Practice Address - Country:US
Practice Address - Phone:541-593-8622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT5097743416L0300X
ORE2247373416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006474Medicaid
OR122804OtherOMAP
OR206476OtherDHS EDI
ORR115968Medicare ID - Type Unspecified