=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982740890
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TENSED AMBULANCE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 HWY 95
-----------------------------------------------------
City | TENSED
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83870-0006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-274-3026
-----------------------------------------------------
Fax | 208-274-3026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6 311 HWY 95
-----------------------------------------------------
City | TENSED
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83870-0006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-274-3026
-----------------------------------------------------
Fax | 208-274-3026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MRS. LEANN DAMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-274-3026
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 5108
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------