MEDICARE: NORTHWEST PARAMEDIC ASSOCIATES INC.

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	8325	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010014961	OTHER	ID	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	E0930	OTHER	ID	BLUE CROSS

General Provider Information

NPI Number	:	1366647505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST PARAMEDIC ASSOCIATES INC.

Provider Business Mailing Address
First Line	:	10400 W OVERLAND RD
Second Line	:	#105
City	:	BOISE
State	:	ID
Zip	:	83709-1433
Country	:	US
Telephone Number	:	208-559-2427
Fax Number	:	855-563-2427

Provider Business Practice Location Address
First Line	:	10400 W OVERLAND RD
Second Line	:	#105
City	:	BOISE
State	:	ID
Zip	:	83709-1433
Country	:	US
Telephone Number	:	208-559-2427
Fax Number	:	855-563-2427

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KARL DEWITT VOGT
Credential	:
Telephone Number	:	208-559-2427

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	04/19/2012

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