MEDICARE: COUNCIL VALLEY 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	341600000X	Ambulance	5310	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E0153	OTHER	ID	BLUE CROSS
2	00010014291	OTHER	ID	BLUE SHIELD

General Provider Information

NPI Number	:	1861558868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNCIL VALLEY AMBULANCE

Provider Business Mailing Address
First Line	:	205 N BERKLEY
Second Line	:	PO BOX 390
City	:	COUNCIL
State	:	ID
Zip	:	83612-0390
Country	:	US
Telephone Number	:	208-253-4778
Fax Number	:	208-253-4778

Provider Business Practice Location Address
First Line	:	205 N BERKLEY
Second Line	:
City	:	COUNCIL
State	:	ID
Zip	:	83612-0390
Country	:	US
Telephone Number	:	208-253-4778
Fax Number	:	208-253-4778

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAN L HUTER
Credential	:	EMT
Telephone Number	:	208-253-4560

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/22/2020

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Directions to “COUNCIL VALLEY AMBULANCE ” Practice Location

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