Canby Fire District 62
Organization Active NPI Land Ambulance · Canby, OR
NPI 1356368302 · NPPES record last updated Dec 9, 2016
Key facts
- NPI
- 1356368302
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 0318 (OR)
- Legal business name
- CANBY FIRE DISTRICT 62
- Practice address
- 221 S Pine St
Canby, OR 97013-4525 - Phone
- (503) 266-5851
- Fax
- (503) 266-1320
- NPI assigned
- Jul 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Matthew S Dale
- Title
- Division Chief, EMS & Safety
- Phone
- (503) 263-4251
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 38D0973177 | Canby Fire District #62 Dba | Certificate of waiver | Apr 26, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090113000886 | OR | Part B Supplier - Ambulance Service Supplier | 5799848925 | Practice locations: Canby, OR |
National Provider Directory
Locations
221 S Pine St
Canby, OR 97013
Phone (503) 266-5851
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 0318 | OR | Yes |
Addresses
Primary practice location
221 S Pine St
Canby, OR 97013-4525
Mailing address
PO Box 3510
Silverdale, WA 98383-3510
Phone (360) 394-7010
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 073817 | Medicaid | OR |
Other providers in Canby, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.