Provider Demographics
NPI:1336238211
Name:COUNTY OF BENEWAH
Entity Type:Organization
Organization Name:COUNTY OF BENEWAH
Other - Org Name:BENEWAH COUNTY EMS DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:UNIT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-245-5304
Mailing Address - Street 1:220 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-1704
Mailing Address - Country:US
Mailing Address - Phone:208-245-5304
Mailing Address - Fax:208-245-5305
Practice Address - Street 1:220 S 9TH ST
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-1704
Practice Address - Country:US
Practice Address - Phone:208-245-5304
Practice Address - Fax:208-245-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7113341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002807000Medicaid
IDE-0138OtherBLUE CROSS
ID000010014388OtherREGENCE BLUE SHIELD
ID826000256 83861 0000OtherTRICARE INSURANCE