Lake Chinook Fire & Rescue
Organization Active NPI Ambulance · Culver, OR
NPI 1396296406 · NPPES record last updated Oct 24, 2016
Key facts
- NPI
- 1396296406
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulance 341600000X
- Legal business name
- LAKE CHINOOK FIRE & RESCUE
- Practice address
- 11700 SW Graham Rd
Culver, OR 97734 - Phone
- (541) 629-8911
- NPI assigned
- Oct 24, 2016
- Organization subpart
- No
Authorized official
- Name
- Don Colfels
- Title
- Fire Chief
- Phone
- (541) 629-8911
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 38D2119329 | Lake Chinook Fire & Rescue | Certificate of waiver | Sep 22, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191212002498 | OR | Part B Supplier - Ambulance Service Supplier | 6709219397 | Practice locations: Culver, OR |
National Provider Directory
Locations
11700 SW Graham Rd
Culver, OR 97734
Phone (541) 629-8911
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | Yes |
Addresses
Primary practice location
11700 SW Graham Rd
Culver, OR 97734
Mailing address
11700 SW Graham Rd
Culver, OR 97734
Phone (541) 629-8911
Other providers in Culver, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 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.