Provider Demographics
NPI:1154314987
Name:KOOTENAI COUNTY EMERGENCY MEDICAL SERVICES SYSTEM
Entity Type:Organization
Organization Name:KOOTENAI COUNTY EMERGENCY MEDICAL SERVICES SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ABRAHAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-930-4224
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3510
Mailing Address - Country:US
Mailing Address - Phone:360-394-7020
Mailing Address - Fax:360-394-7099
Practice Address - Street 1:4381 W SELTICE WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-8910
Practice Address - Country:US
Practice Address - Phone:208-930-4224
Practice Address - Fax:208-930-4259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
ID81463416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA136705OtherLABOR & INDUSTRIES
ID590013218OtherRAILROAD MEDICARE PTAN
610071400OtherOWCP
ID805416900Medicaid
OR299900Medicaid
WA9048224Medicaid
WA9048224Medicaid