1740251925 NPI number — ADA BOI INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740251925 NPI number — ADA BOI INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADA BOI INC
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:
ADA-BOI CRITICAL CARE TRANSPORT SERVICE
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:
1740251925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190480
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83719-0480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-362-2973
Provider Business Mailing Address Fax Number:
208-362-0854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7701 W MOSSY CUP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83709-2844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-362-2973
Provider Business Practice Location Address Fax Number:
208-362-0854
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOGG
Authorized Official First Name:
KATHIE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
208-362-2973

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  8405 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 8405 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000010014479 . This is a "BLUE SHIELD OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002496600 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: E0419 . This is a "TRUE BLUE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: E0419 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 590157443 . This is a "RR MEDICARE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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