Polk County Fire District No.1

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

2703-06 Issued in OR

Legal business name

POLK COUNTY FIRE DISTRICT NO.1

Practice address

1800 Monmouth St
Not Applicable
Independence, OR 97351-9700

Phone

(503) 838-1510

Fax

(503) 838-1235

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Susan Jean Shepard

Title

Offie Administrator

Phone

(503) 838-1510

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376620799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 MONMOUTH ST",
            "city": "INDEPENDENCE",
            "state": "OR",
            "postal_code": "973519700",
            "telephone_number": "503-838-1510",
            "fax_number": "503-838-1235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 MONMOUTH ST",
            "address_2": "NOT APPLICABLE",
            "city": "INDEPENDENCE",
            "state": "OR",
            "postal_code": "973519700",
            "telephone_number": "503-838-1510",
            "fax_number": "503-838-1235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK COUNTY FIRE DISTRICT NO.1",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHEPARD",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OFFIE ADMINISTRATOR",
        "authorized_official_telephone_number": "503-838-1510"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "OR",
            "license": "2703-06",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119461",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jack Lee Otterstrom, LCSW
• Brittany Evon Perkins, RDH
• Arthur A Peters, LMT
• Lizzett Piza
• Mary Susanne Placek, M.D.
• Polk, Yamhill, & Marion Treatment Services
• Carly Polland, ND
• Bathsheba Shunquita Queen, BSN, MSN
• R&J Mobility Service, LLC
• Restoration Health

• Land Ambulance in Independence, OR
• Providers in Independence, OR by specialty
• Land Ambulance in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.