Healthcare Provider Details

I. General information

NPI: 1316026867
Provider Name (Legal Business Name): COUNTY OF FREMONT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N BRIDGE ST
SAINT ANTHONY ID
83445-5004
US

IV. Provider business mailing address

PO BOX 3510
SILVERDALE WA
98383-3510
US

V. Phone/Fax

Practice location:
  • Phone: 208-624-7557
  • Fax:
Mailing address:
  • Phone: 360-394-7010
  • Fax: 360-394-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number7704
License Number StateID

VIII. Authorized Official

Name: ROBERT FOSTER
Title or Position: TREASURER
Credential:
Phone: 208-624-7557