Provider Demographics
NPI:1114142833
Name:CITY OF KOOSKIA
Entity Type:Organization
Organization Name:CITY OF KOOSKIA
Other - Org Name:KOOSKIA AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:ENGBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-926-4858
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:KOOSKIA
Mailing Address - State:ID
Mailing Address - Zip Code:83539-0339
Mailing Address - Country:US
Mailing Address - Phone:208-926-4858
Mailing Address - Fax:208-926-4858
Practice Address - Street 1:001 4TH AVE
Practice Address - Street 2:
Practice Address - City:KOOSKIA
Practice Address - State:ID
Practice Address - Zip Code:83539
Practice Address - Country:US
Practice Address - Phone:208-926-0172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7215341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance