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General NPI Number Information
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NPI Number | 1114926151
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Entity Type | Organization
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Legal Business Name | CANYON COUNTY AMBULANCE DISTRICT
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 6116 GRAYE LANE
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City | CALDWELL
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State | ID
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Zip | 83607-8072
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Country | US
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Telephone | 208-795-6920
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Fax | 208-795-6921
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Provider Business Mailing Address
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Address Line | 6116 GRAYE LANE
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City | CALDWELL
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State | ID
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Zip | 83607-8072
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Country | US
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Telephone | 208-795-6920
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Fax | 208-795-6921
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. GREG D OWEN
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Credential |
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Telephone | 208-795-6920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 8301
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 7479
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License Number State | ID
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