Healthcare Provider Details

I. General information

NPI: 1245434380
Provider Name (Legal Business Name): THE VOLUNTEER FIRE DEPARTMENT OF MOSCOW, IDAHO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S MAIN ST
MOSCOW ID
83843
US

IV. Provider business mailing address

603 S MAIN ST
MOSCOW ID
83843-3039
US

V. Phone/Fax

Practice location:
  • Phone: 208-883-7081
  • Fax: 208-883-7083
Mailing address:
  • Phone: 208-882-2831
  • Fax: 208-882-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number7203
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number7203
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number7203
License Number StateID

VIII. Authorized Official

Name: RICHARD DAVID REYNOLDS
Title or Position: EMS DIVISION CHIEF
Credential:
Phone: 208-883-7081