Provider Demographics
NPI:1417051566
Name:ELK CITY AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:ELK CITY AMBULANCE SERVICE INC
Other - Org Name:ELK CITY AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:AUBREE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-660-6990
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83525-0206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 AMERICAN RIVER RD
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:ID
Practice Address - Zip Code:83525-0206
Practice Address - Country:US
Practice Address - Phone:208-842-2626
Practice Address - Fax:208-842-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID52013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010014427OtherBLUE SHIELD
ID8053487Medicaid
IDE0781OtherBLUE CROSS
ID590012801OtherRAILROAD MEDICARE
ID8053487Medicaid