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General NPI Number Information
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NPI Number | 1801920251
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Entity Type | Organization
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Legal Business Name | BOUNDARY VOLUNTEER AMBULANCE SERVICE INC.
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 6447 RAILROAD STREET
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City | BONNERS FERRY
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State | ID
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Zip | 83805-6447
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Country | US
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Telephone | 208-267-2604
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Fax | 208-267-9408
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Provider Business Mailing Address
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Address Line | PO BOX 441
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City | BONNERS FERRY
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State | ID
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Zip | 83805-0441
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Country | US
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Telephone | 208-267-2604
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Fax | 208-267-9408
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Authorized Official
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Title or Position | CHIEF
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Name | MR. KENNETH V BAKER
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Credential |
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Telephone | 208-267-2604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 1500244
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License Number State | ID
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