1912915448 NPI number — COUNTY OF GEM

Table of content: (NPI 1912915448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912915448 NPI number — COUNTY OF GEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF GEM
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:
GEM COUNTY AMBULANCE
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:
1912915448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 E MAIN ST
Provider Second Line Business Mailing Address:
RM. 202
Provider Business Mailing Address City Name:
EMMETT
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83617-3059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-365-3684
Provider Business Mailing Address Fax Number:
208-365-3683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMMETT
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83617-3034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-365-3684
Provider Business Practice Location Address Fax Number:
208-365-3683
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
JEANIE
Authorized Official Middle Name:
EDITH M.
Authorized Official Title or Position:
DEPUTY EMT- BILLING
Authorized Official Telephone Number:
208-365-3684

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  7306 , 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)

  • Identifier: 1500010 . This is a "MEDICARE ID - TYPE UNSPEC" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 275436 . This is a "OMAP" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010015165 . This is a "BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: E019-5 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com