Provider Demographics
NPI:1811999535
Name:SOUTH LINCOLN AMBULANCE INC.
Entity type:Organization
Organization Name:SOUTH LINCOLN AMBULANCE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE CHIEF
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-547-3266
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:YACHATS
Mailing Address - State:OR
Mailing Address - Zip Code:97498-0031
Mailing Address - Country:US
Mailing Address - Phone:541-547-3766
Mailing Address - Fax:541-547-4257
Practice Address - Street 1:215 W 2ND ST
Practice Address - Street 2:
Practice Address - City:YACHATS
Practice Address - State:OR
Practice Address - Zip Code:97498
Practice Address - Country:US
Practice Address - Phone:541-547-3266
Practice Address - Fax:541-547-4257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2112-06146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006352000OtherBCBS
OR189407Medicaid
OR189407Medicaid