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General NPI Number Information
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NPI Number | 1720073307
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Entity Type | Organization
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Legal Business Name | WORLEY AMBULANCE ASSOCIATION, INC.
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 9816 I STREET
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City | WORLEY
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State | ID
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Zip | 83876
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Country | US
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Telephone | 208-686-1883
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Fax | 208-686-3604
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | WORLEY
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State | ID
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Zip | 83876-0069
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Country | US
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Telephone | 208-686-1883
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Fax | 208-686-3604
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. CHARLENE E. WADDELL
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Credential |
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Telephone | 208-686-1883
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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 | 7107
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License Number State | ID
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