Provider Demographics
NPI:1700889987
Name:COUNTY OF ADA
Entity Type:Organization
Organization Name:COUNTY OF ADA
Other - Org Name:ADA COUNTY EMERGENCY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-287-2965
Mailing Address - Street 1:370 N. BENJAMIN LANE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-287-2950
Mailing Address - Fax:208-287-2999
Practice Address - Street 1:370 N. BENJAMIN LANE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-287-2950
Practice Address - Fax:208-287-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID84073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDE002-1OtherBLUE CROSS
WA9535501Medicaid
ID000010014241OtherBLUE SHIELD
OR192187Medicaid
ID002807200Medicaid
CAXMTE06322Medicaid
ID1504057Medicare ID - Type Unspecified