Provider Demographics
NPI:1366647505
Name:NORTHWEST PARAMEDIC ASSOCIATES INC.
Entity Type:Organization
Organization Name:NORTHWEST PARAMEDIC ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:DEWITT
Authorized Official - Last Name:VOGT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-559-2427
Mailing Address - Street 1:10400 W OVERLAND RD
Mailing Address - Street 2:#105
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1433
Mailing Address - Country:US
Mailing Address - Phone:208-559-2427
Mailing Address - Fax:855-563-2427
Practice Address - Street 1:10400 W OVERLAND RD
Practice Address - Street 2:#105
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1433
Practice Address - Country:US
Practice Address - Phone:208-559-2427
Practice Address - Fax:855-563-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID83253416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010014961OtherBLUE SHIELD
ID804084900Medicaid
IDE0930OtherBLUE CROSS
IDE0930OtherBLUE CROSS