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General NPI Number Information
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NPI Number | 1093520298
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Entity Type | Individual
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Provider Name | CODY DEAN KILLMAR PARAMEDIC
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Gender | Male
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 126 N MAIN ST
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City | RIGGINS
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State | ID
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Zip | 83549-0055
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Country | US
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Telephone | 208-628-3394
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Fax |
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Provider Business Mailing Address
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Address Line | 150 HEATH DR
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City | RIGGINS
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State | ID
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Zip | 83549-5011
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Country | US
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Telephone | 208-983-9263
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 170373
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License Number State | ID
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