Provider Demographics
NPI:1982696449
Name:CARIBOU COUNTY
Entity Type:Organization
Organization Name:CARIBOU COUNTY
Other - Org Name:CARIBOU COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMMERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-547-2583
Mailing Address - Street 1:PO BOX 775
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83276-0775
Mailing Address - Country:US
Mailing Address - Phone:208-547-2583
Mailing Address - Fax:208-547-2593
Practice Address - Street 1:40 W CENTER ST
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276-1531
Practice Address - Country:US
Practice Address - Phone:208-547-2583
Practice Address - Fax:208-547-2593
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARIBOU COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID56043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002328200Medicaid
ID002328200Medicaid