Provider Demographics
NPI:1255425286
Name:WEISER AMBULANCE DISTRICT
Entity type:Organization
Organization Name:WEISER AMBULANCE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:D
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-466-8800
Mailing Address - Street 1:P.O. BOX 670
Mailing Address - Street 2:256 E COURT ST.
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-0670
Mailing Address - Country:US
Mailing Address - Phone:208-414-1636
Mailing Address - Fax:208-414-4255
Practice Address - Street 1:435 E. PARK ST.
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-2265
Practice Address - Country:US
Practice Address - Phone:208-414-4257
Practice Address - Fax:208-414-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8304341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002810100Medicaid
IDE0385OtherBLUE CROSS
ID002810100Medicaid