MEDICARE: TROY VOLUNTEER FIRE AND AMBULANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	7217	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7217	OTHER	ID	EMS LICENSE NUMBER

General Provider Information

NPI Number	:	1275900425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TROY VOLUNTEER FIRE AND AMBULANCE

Provider Business Mailing Address
First Line	:	109 W 6TH ST
Second Line	:
City	:	TROY
State	:	ID
Zip	:	83871
Country	:	US
Telephone Number	:	208-835-2601
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 W 6TH ST
Second Line	:
City	:	TROY
State	:	ID
Zip	:	83871
Country	:	US
Telephone Number	:	208-835-2601
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JESSICA RENFROW
Credential	:
Telephone Number	:	208-596-2636

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	05/23/2023

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Directions to “TROY VOLUNTEER FIRE AND AMBULANCE ” Practice Location

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