Healthcare Provider Details

I. General information

NPI: 1306838859
Provider Name (Legal Business Name): CITY OF LEWISTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 F ST
LEWISTON ID
83501-1930
US

IV. Provider business mailing address

PO BOX 617
LEWISTON ID
83501-0617
US

V. Phone/Fax

Practice location:
  • Phone: 208-746-3671
  • Fax: 208-746-1907
Mailing address:
  • Phone: 208-746-3671
  • Fax: 208-746-1907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number40M01
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number8210
License Number StateID

VIII. Authorized Official

Name: DANIEL J MARSH
Title or Position: ADMINISTRATIVE SERVICES DIRECTOR
Credential:
Phone: 208-746-3671