Provider Demographics
NPI:1912915448
Name:COUNTY OF GEM
Entity Type:Organization
Organization Name:COUNTY OF GEM
Other - Org Name:GEM COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY EMT- BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:EDITH M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-I
Authorized Official - Phone:208-365-3684
Mailing Address - Street 1:415 E MAIN ST
Mailing Address - Street 2:RM. 202
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-3059
Mailing Address - Country:US
Mailing Address - Phone:208-365-3684
Mailing Address - Fax:208-365-3683
Practice Address - Street 1:330 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-3034
Practice Address - Country:US
Practice Address - Phone:208-365-3684
Practice Address - Fax:208-365-3683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID73063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1500010OtherMEDICARE ID - TYPE UNSPEC
ID275436OtherOMAP
ID000010015165OtherBLUE SHIELD
IDE019-5OtherBLUE CROSS