1154314987 NPI number — KOOTENAI COUNTY EMERGENCY MEDICAL SERVICES SYSTEM

Table of content: (NPI 1154314987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154314987 NPI number — KOOTENAI COUNTY EMERGENCY MEDICAL SERVICES SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOOTENAI COUNTY EMERGENCY MEDICAL SERVICES SYSTEM
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:
Provider Other Organization Name Type Code:
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:
1154314987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-394-7020
Provider Business Mailing Address Fax Number:
360-394-7099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4381 W SELTICE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-8910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-930-4224
Provider Business Practice Location Address Fax Number:
208-930-4259
Provider Enumeration Date:
08/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ABRAHAMSON
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
208-930-4224

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 8146 , 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: 136705 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 590013218 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 610071400 . This is a "OWCP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 805416900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 299900 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9048224 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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