Provider Demographics
NPI:1578568473
Name:COUNTY OF FRANKLIN
Entity Type:Organization
Organization Name:COUNTY OF FRANKLIN
Other - Org Name:FRANKLIN COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-339-0803
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:55 W 100 S
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-0085
Mailing Address - Country:US
Mailing Address - Phone:208-852-3764
Mailing Address - Fax:208-852-5561
Practice Address - Street 1:55 W 100 S
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263-1202
Practice Address - Country:US
Practice Address - Phone:208-852-3764
Practice Address - Fax:208-852-5561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF FRANKLIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-16
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7614341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001404560OtherREGENCE BLUE SHIELD OF ID
ID002808700Medicaid
IDE0187OtherBLUE CROSS
GA590157501OtherPALMETTO GBA
IDE0187OtherBLUE CROSS