MEDICARE: CARIBOU COUNTY

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	5604	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982696449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARIBOU COUNTY

Provider Business Mailing Address
First Line	:	PO BOX 775
Second Line	:
City	:	SODA SPRINGS
State	:	ID
Zip	:	83276-0775
Country	:	US
Telephone Number	:	208-547-2583
Fax Number	:	208-547-2593

Provider Business Practice Location Address
First Line	:	40 W CENTER ST
Second Line	:
City	:	SODA SPRINGS
State	:	ID
Zip	:	83276-1531
Country	:	US
Telephone Number	:	208-547-2583
Fax Number	:	208-547-2593

Authorized Official
Title or Position	:	ADMIN ASSISTANT
Name	:	LINDA HEMMERT
Credential	:
Telephone Number	:	208-547-2583

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	07/19/2017

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Directions to “CARIBOU COUNTY ” Practice Location

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