Healthcare Provider Details

I. General information

NPI: 1700889987
Provider Name (Legal Business Name): COUNTY OF ADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 N. BENJAMIN LANE
BOISE ID
83704
US

IV. Provider business mailing address

370 N. BENJAMIN LANE
BOISE ID
83704
US

V. Phone/Fax

Practice location:
  • Phone: 208-287-2950
  • Fax: 208-287-2999
Mailing address:
  • Phone: 208-287-2950
  • Fax: 208-287-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number8407
License Number StateID

VIII. Authorized Official

Name: MR. TROY M. HAGEN
Title or Position: DIRECTOR
Credential:
Phone: 208-287-2965