Provider Demographics
NPI:1528116175
Name:CLATSKANIE RURAL FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:CLATSKANIE RURAL FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TISDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-728-2025
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:CLATSKANIE
Mailing Address - State:OR
Mailing Address - Zip Code:97016-0807
Mailing Address - Country:US
Mailing Address - Phone:503-728-2025
Mailing Address - Fax:503-728-4388
Practice Address - Street 1:280 SE THIRD ST.
Practice Address - Street 2:
Practice Address - City:CLATSKANIE
Practice Address - State:OR
Practice Address - Zip Code:97016
Practice Address - Country:US
Practice Address - Phone:503-728-2025
Practice Address - Fax:503-728-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0501341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027433OtherOMAP PROVIDER NUMBER
OR027433Medicaid
WA9574609Medicaid
OR027433Medicaid