NPIMap

Organization Active NPI

Bonanza Quick Response Team

  • Ambulance
  • Bonanza, OR
National Provider Identifier
1336218189
Registry record updated Jul 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
License
T520620 Issued in OR
Legal business name
BONANZA QUICK RESPONSE TEAM
Practice address
3100 E. Langell Valley Rd.
Bonanza, OR 97623
Phone
(541) 892-5537
Fax
(541) 545-6553
NPI assigned
Nov 7, 2006
Last updated
Jul 8, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
BONANZA QUICK RESPONSE TEAMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 8, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Pamela Faye Wiersma
Title
President
Phone
(541) 892-8106

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X T520620 OR Primary

Addresses

Primary practice location

3100 E. Langell Valley Rd.
Bonanza, OR 97623

Mailing address

PO Box 363
Bonanza, OR 97623
Phone (541) 892-5537

Other identifiers 1

IdentifierTypeStateIssuer
165100MedicaidOR

Other names 1

  • Bonanza Ambulance Former legal business name

National Provider Directory

National Provider Directory
Part of
Bonanza Quick Response Team

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467936000000",
    "number": "1336218189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 363",
            "city": "BONANZA",
            "state": "OR",
            "postal_code": "97623",
            "telephone_number": "541-892-5537",
            "fax_number": "541-545-6553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 E. LANGELL VALLEY RD.",
            "city": "BONANZA",
            "state": "OR",
            "postal_code": "97623",
            "telephone_number": "541-892-5537",
            "fax_number": "541-545-6553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONANZA QUICK RESPONSE TEAM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BONANZA QUICK RESPONSE TEAM",
        "enumeration_date": "2006-11-07",
        "last_updated": "2016-07-08",
        "status": "A",
        "authorized_official_last_name": "WIERSMA",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "FAYE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-892-8106"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "OR",
            "license": "T520620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165100",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bonanza Ambulance",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bonanza, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.