=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366647505
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHWEST PARAMEDIC ASSOCIATES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2007
-----------------------------------------------------
Last Update Date | 04/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10400 W OVERLAND RD #105
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83709-1433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-559-2427
-----------------------------------------------------
Fax | 855-563-2427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10400 W OVERLAND RD #105
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83709-1433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-559-2427
-----------------------------------------------------
Fax | 855-563-2427
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. KARL DEWITT VOGT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-559-2427
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 8325
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------