Active NPI
Tualatin Valley Fire & Rescue
- Land Ambulance
- Tigard, OR
National Provider Identifier
1467879858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- License
- 3402
- Legal business name
- TUALATIN VALLEY FIRE & RESCUE
- Practice address
- 11945 SW 70TH Ave
Tigard, OR 97223-9196 - Phone
- (503) 649-8577
- Fax
- (503) 649-5347
- NPI assigned
- Mar 24, 2014
- Organization subpart
- Yes
- Parent organization
- TUALATIN VALLEY FIRE & RESCUE
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael R. Duyck
- Title
- Fire Chief
- Phone
- (503) 649-8577
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 3402 | OR | Primary |
Addresses
Primary practice location
11945 SW 70TH Ave
Tigard, OR 97223-9196
Mailing address
11945 SW 70TH Ave
Tigard, OR 97223-9196
Phone (503) 649-8577
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E247005 | Other | OR | AMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM |
| E247641 | Other | OR | AMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM |
| 3402 | Other | OR | DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM |
| E247006 | Other | OR | AMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM |
| E247619 | Other | OR | AMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120424000112 | OR | Part B Supplier - Ambulance Service Supplier | 8820250632 |
1 other NPI on this enrollment Practice locations: Tigard, OR |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Tualatin Valley Fire Rescue
- Part of
- Tualatin Valley Fire Rescue
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Land Ambulance
- Tigard, OR
- NPI 1750652673
Locations
11945 SW 70th Ave
Tigard, OR 97223
Phone (503) 259-1129
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Land Ambulance
- Tigard, OR
- NPI 1750652673
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Paramedic
- Tigard, OR
- NPI 1235050402
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395619200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1395619200000",
"number": "1467879858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11945 SW 70TH AVE",
"city": "TIGARD",
"state": "OR",
"postal_code": "972239196",
"telephone_number": "503-649-8577",
"fax_number": "503-649-5347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11945 SW 70TH AVE",
"city": "TIGARD",
"state": "OR",
"postal_code": "972239196",
"telephone_number": "503-649-8577",
"fax_number": "503-649-5347"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TUALATIN VALLEY FIRE & RESCUE",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "TUALATIN VALLEY FIRE & RESCUE",
"enumeration_date": "2014-03-24",
"last_updated": "2014-03-24",
"status": "A",
"authorized_official_last_name": "DUYCK",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "R.",
"authorized_official_title_or_position": "FIRE CHIEF",
"authorized_official_telephone_number": "503-649-8577"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "OR",
"license": "3402",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM",
"identifier": "E247005",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM",
"identifier": "E247641",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM",
"identifier": "3402",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM",
"identifier": "E247006",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMBULANCE CERTIFICATION, DEPT. OF HUMAN SERVICES EMS & TRAUMA SYSTEM PROGRAM",
"identifier": "E247619",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2014; 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.