Provider Demographics
NPI:1245434380
Name:THE VOLUNTEER FIRE DEPARTMENT OF MOSCOW, IDAHO INC.
Entity type:Organization
Organization Name:THE VOLUNTEER FIRE DEPARTMENT OF MOSCOW, IDAHO INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIVISION CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-883-7081
Mailing Address - Street 1:603 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3039
Mailing Address - Country:US
Mailing Address - Phone:208-882-2831
Mailing Address - Fax:208-882-5746
Practice Address - Street 1:603 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843
Practice Address - Country:US
Practice Address - Phone:208-883-7081
Practice Address - Fax:208-883-7083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7203146M00000X, 146N00000X, 146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Multi-Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1500299Medicare ID - Type Unspecified