Healthcare Provider Details

I. General information

NPI: 1184785248
Provider Name (Legal Business Name): CLEARWATER COUNTY DBA BACK COUNTRY MEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 AIRPORT ROAD BOX 586
OROFINO ID
83544-0586
US

IV. Provider business mailing address

PO BOX 586 150 MICHIGAN AVE
OROFINO ID
83544-0586
US

V. Phone/Fax

Practice location:
  • Phone: 208-476-5615
  • Fax: 208-476-9315
Mailing address:
  • Phone: 208-476-5615
  • Fax: 208-476-9315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number6228
License Number StateID

VIII. Authorized Official

Name: MR. NICK R ALBERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-476-3057