1881691491 NPI number — COUNTY OF POWER

Table of content: (NPI 1881691491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881691491 NPI number — COUNTY OF POWER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF POWER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
POWER COUNTY EMS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881691491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
543 BANNOCK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMERICAN FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83211-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-226-5605
Provider Business Mailing Address Fax Number:
208-226-7829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 N OREGON TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMERICAN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83211-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-226-5605
Provider Business Practice Location Address Fax Number:
208-226-7829
Provider Enumeration Date:
06/29/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FUNK
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD CHAIRMAN
Authorized Official Telephone Number:
208-339-2129

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  7620 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)