Provider Demographics
NPI:1114925617
Name:CITY OF IDAHO FALLS
Entity Type:Organization
Organization Name:CITY OF IDAHO FALLS
Other - Org Name:CITY OF IDAHO FALLS AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-612-8173
Mailing Address - Street 1:PO BOX 269110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-9110
Mailing Address - Country:US
Mailing Address - Phone:916-669-4613
Mailing Address - Fax:
Practice Address - Street 1:343 E ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402
Practice Address - Country:US
Practice Address - Phone:208-612-8452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID87053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID32466OtherDMBA
ID421OtherSTATE INSURANCE FUND
ID8180029OtherUNITED HEALTHCARE
UT197470OtherALTIUS HEALTH PLANS
IDE0229OtherBLUE CROSS OF IDAHO
ID000010034871OtherREGENCE BLUE SHIELD OF ID
AZDA0003OtherHEALTH NET
OR213131Medicaid
GA590157453OtherPALMETTO, GBA
ID826000280OtherTRICARE - WBS
ID002806100Medicaid
MT0441688Medicaid
ID274655001OtherEMPLOYER'S MUTUAL
KY60054OtherAETNA