Provider Demographics
NPI:1649295551
Name:CITY OF FRUITLAND
Entity type:Organization
Organization Name:CITY OF FRUITLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-452-4421
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-0324
Mailing Address - Country:US
Mailing Address - Phone:208-452-4421
Mailing Address - Fax:208-452-6146
Practice Address - Street 1:200 S WHITLEY DR
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2537
Practice Address - Country:US
Practice Address - Phone:208-452-4421
Practice Address - Fax:208-452-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3330341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1514191Medicare ID - Type UnspecifiedMEDICARE