Provider Demographics
NPI:1235335415
Name:MARSING AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:MARSING AMBULANCE SERVICE INC
Other - Org Name:MARSING AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:AMBULANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-407-0300
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:MARSING
Mailing Address - State:ID
Mailing Address - Zip Code:83639-0132
Mailing Address - Country:US
Mailing Address - Phone:208-869-5563
Mailing Address - Fax:208-429-6565
Practice Address - Street 1:303 MAIN
Practice Address - Street 2:
Practice Address - City:MARSING
Practice Address - State:ID
Practice Address - Zip Code:83639
Practice Address - Country:US
Practice Address - Phone:208-869-5563
Practice Address - Fax:208-429-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID#5312341600000X
ID53123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDE0278OtherBLUE CROSS
ID000010014364OtherBLUE SHIELD
ID002868900Medicaid
ID000010014364OtherBLUE SHIELD