Provider Demographics
NPI:1972609923
Name:AMERICAN MEDICAL RESPONSE NORTHWEST INC
Entity type:Organization
Organization Name:AMERICAN MEDICAL RESPONSE NORTHWEST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-703-2294
Mailing Address - Street 1:PO BOX 749667
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-9667
Mailing Address - Country:US
Mailing Address - Phone:800-913-9106
Mailing Address - Fax:
Practice Address - Street 1:20665 SW BLANTON ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97078-1042
Practice Address - Country:US
Practice Address - Phone:503-736-3509
Practice Address - Fax:971-394-4034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR194135303OtherUS DOL - FECA
WA1972609923Medicaid
AKGA003ORMedicaid
OR227896Medicaid
OR279040Medicaid
OROR0000D100173OtherSECTION 1011
OROR0000D100173OtherSECTION 1011
OR194135303OtherUS DOL - FECA