1982740890 NPI number — TENSED AMBULANCE SERVICE

Table of content: (NPI 1982740890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982740890 NPI number — TENSED AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENSED AMBULANCE SERVICE
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:
1982740890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6
Provider Second Line Business Mailing Address:
311 HWY 95
Provider Business Mailing Address City Name:
TENSED
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83870-0006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-274-3026
Provider Business Mailing Address Fax Number:
208-274-3026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 HWY 95
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TENSED
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83870-0006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-274-3026
Provider Business Practice Location Address Fax Number:
208-274-3026
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAMAN
Authorized Official First Name:
LEANN
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
208-274-3026

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  5108 , 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: 000010014323 . This is a "REGENCE BS IDAHO #" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: E0872 . This is a "BLUE CROSS OF IDAHO #" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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