=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346631058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEADOWS VALLEY RURAL FIRE DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2015
-----------------------------------------------------
Last Update Date | 08/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 HWY 95
-----------------------------------------------------
City | NEW MEADOWS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-347-3190
-----------------------------------------------------
Fax | 208-347-3190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 523
-----------------------------------------------------
City | NEW MEADOWS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-347-3190
-----------------------------------------------------
Fax | 208-347-3190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMIN ASSISTANT
-----------------------------------------------------
Name | CODY DEAN KILLMAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-983-9263
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 5313
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------