Provider Demographics
NPI:1033112594
Name:CITY OF SALEM
Entity type:Organization
Organization Name:CITY OF SALEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIBLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-588-6245
Mailing Address - Street 1:2742 25TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1108
Mailing Address - Country:US
Mailing Address - Phone:503-588-6271
Mailing Address - Fax:503-588-6202
Practice Address - Street 1:2742 25TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1108
Practice Address - Country:US
Practice Address - Phone:503-588-6271
Practice Address - Fax:503-588-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2411053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR590009956OtherRAILROAD MEDICARE PIN
OR170191Medicaid
OR590009956OtherRAILROAD MEDICARE PIN