Provider Demographics
NPI:1184754053
Name:MAGIC VALLEY PARAMEDICS , LTD.
Entity type:Organization
Organization Name:MAGIC VALLEY PARAMEDICS , LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-737-2101
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-0367
Mailing Address - Country:US
Mailing Address - Phone:208-814-7459
Mailing Address - Fax:208-814-7491
Practice Address - Street 1:285 MARTIN ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4532
Practice Address - Country:US
Practice Address - Phone:208-737-2298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010149121OtherBLUE SHIELD PROV NUMBER
P00719362OtherMEDICARE RR
ID807075100Medicaid
IDE1144OtherBLUE CROSS PROV NUMBER
ID807075100Medicaid
1500011Medicare Oscar/Certification