Healthcare Provider Details

I. General information

NPI: 1336238211
Provider Name (Legal Business Name): COUNTY OF BENEWAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/10/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S 9TH ST
ST MARIES ID
83861-1704
US

IV. Provider business mailing address

220 S 9TH ST
ST MARIES ID
83861-1704
US

V. Phone/Fax

Practice location:
  • Phone: 208-245-5304
  • Fax: 208-245-5305
Mailing address:
  • Phone: 208-245-5304
  • Fax: 208-245-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number7113
License Number StateID

VIII. Authorized Official

Name: MRS. KRISTIN L COMPTON
Title or Position: UNIT DIRECTOR
Credential:
Phone: 208-245-5304