NPIMap

Organization Active NPI

South Gilliam County Ambulance

  • Land Ambulance
  • Condon, OR
National Provider Identifier
1467505883
Registry record updated May 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
1104 Issued in OR
Legal business name
SOUTH GILLIAM COUNTY AMBULANCE
Practice address
422 N Main
Condon, OR 97823-0085
Phone
(541) 384-2061
NPI assigned
Jan 19, 2007
Last updated
May 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2008

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

Authorized official

Name
Cindy Hess
Title
Insurance Clerk
Phone
(541) 384-2061

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 1104 OR Primary

Addresses

Primary practice location

422 N Main
Condon, OR 97823-0085

Mailing address

PO Box 85
Condon, OR 97823-0085

Other identifiers 1

IdentifierTypeStateIssuer
070664MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130416000057 OR Part B Supplier - Ambulance Service Supplier 8628156411 Practice locations: Condon, OR

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212105600000",
    "number": "1467505883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 85",
            "city": "CONDON",
            "state": "OR",
            "postal_code": "978230085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 N MAIN",
            "city": "CONDON",
            "state": "OR",
            "postal_code": "978230085",
            "telephone_number": "541-384-2061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GILLIAM COUNTY AMBULANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2008-05-30",
        "status": "A",
        "authorized_official_last_name": "HESS",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "INSURANCE CLERK",
        "authorized_official_telephone_number": "541-384-2061"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "OR",
            "license": "1104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "070664",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Condon, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.