Healthcare Provider Details

I. General information

NPI: 1083614036
Provider Name (Legal Business Name): BLAINE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 E AVENUE N
KETCHUM ID
83340
US

IV. Provider business mailing address

206 S 1ST AVE SUITE 200
HAILEY ID
83333-8429
US

V. Phone/Fax

Practice location:
  • Phone: 208-788-5505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: JOLYNN DRAGE
Title or Position: CLERK, AUDITOR AND RECORDER
Credential:
Phone: 208-788-5505