Provider Demographics
NPI:1740251925
Name:ADA BOI INC
Entity type:Organization
Organization Name:ADA BOI INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOGG
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:208-362-2973
Mailing Address - Street 1:PO BOX 190480
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0480
Mailing Address - Country:US
Mailing Address - Phone:208-362-2973
Mailing Address - Fax:208-362-0854
Practice Address - Street 1:7701 W MOSSY CUP ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2844
Practice Address - Country:US
Practice Address - Phone:208-362-2973
Practice Address - Fax:208-362-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8405341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010014479OtherBLUE SHIELD OF IDAHO
ID002496600Medicaid
IDE0419OtherTRUE BLUE
IDE0419OtherBLUE CROSS OF IDAHO
ID590157443OtherRR MEDICARE
ID1505533Medicare ID - Type UnspecifiedIDAHO MEDICARE
ID590157443Medicare PIN
ORR0000RGBVSMedicare PIN