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General NPI Number Information
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NPI Number | 1053801035
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Entity Type | Organization
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Legal Business Name | EAST BOISE COUNTY AMBULANCE DISTRICT
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 204 W. COMMERCIAL ST
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City | IDAHO CITY
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State | ID
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Zip | 83631
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Country | US
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Telephone | 208-392-6644
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Fax | 208-392-6644
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Provider Business Mailing Address
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Address Line | PO BOX 1300
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City | IDAHO CITY
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State | ID
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Zip | 83631-1300
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Country | US
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Telephone | 208-392-6644
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Fax | 208-392-6644
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Authorized Official
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Title or Position | DIRECTOR OF OPERTIONS
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Name | ANGELA DILL
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Credential | EMT
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Telephone | 208-392-6644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 5430
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License Number State | ID
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