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General NPI Number Information
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NPI Number | 1700889987
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Entity Type | Organization
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Legal Business Name | COUNTY OF ADA
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 370 N. BENJAMIN LANE
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-287-2950
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Fax | 208-287-2999
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Provider Business Mailing Address
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Address Line | 370 N. BENJAMIN LANE
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-287-2950
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Fax | 208-287-2999
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. TROY M. HAGEN
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Credential |
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Telephone | 208-287-2965
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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 | 8407
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License Number State | ID
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