Provider Demographics
NPI:1639361520
Name:CITY OF RIGGINS
Entity Type:Organization
Organization Name:CITY OF RIGGINS
Other - Org Name:CITY OF RIGGINS AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY CITY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLENBEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-628-3394
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:RIGGINS
Mailing Address - State:ID
Mailing Address - Zip Code:83549-0249
Mailing Address - Country:US
Mailing Address - Phone:208-628-3394
Mailing Address - Fax:208-628-3792
Practice Address - Street 1:126 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RIGGINS
Practice Address - State:ID
Practice Address - Zip Code:83549
Practice Address - Country:US
Practice Address - Phone:208-628-3394
Practice Address - Fax:208-628-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID72133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002616500Medicaid
ID000010014266OtherBLUE SHIELD
IDE0641OtherBLUE CROSS
ID002616500Medicaid