Provider Demographics
NPI:1497970511
Name:FIRE DISTRICT 2
Entity Type:Organization
Organization Name:FIRE DISTRICT 2
Other - Org Name:SWAN VALLEY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILBRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-520-7242
Mailing Address - Street 1:PO BOX 52261
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83405-2261
Mailing Address - Country:US
Mailing Address - Phone:208-520-7242
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 31
Practice Address - Street 2:#15
Practice Address - City:SWAN VALLEY
Practice Address - State:ID
Practice Address - Zip Code:83449
Practice Address - Country:US
Practice Address - Phone:208-520-7242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID57103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID5710OtherEMS LICENSE