Provider Demographics
NPI:1982727988
Name:COUNTY OF GOODING
Entity Type:Organization
Organization Name:COUNTY OF GOODING
Other - Org Name:GOODING COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-A
Authorized Official - Phone:208-934-4841
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-0417
Mailing Address - Country:US
Mailing Address - Phone:208-934-4015
Mailing Address - Fax:208-934-5260
Practice Address - Street 1:145 7TH AVE E
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-1660
Practice Address - Country:US
Practice Address - Phone:208-934-4015
Practice Address - Fax:208-934-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID75043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010014306OtherBLUE SHIELD OF IDAHO
ID002809000Medicaid
GAGOODINGOtherAARP
UT32473OtherDESERET MUTUAL DENEFIT
IDE0724OtherBLUE CROSS OF IDAHO
NV003288350Medicaid
UT8200060000002OtherBC BS UTAH
ID000010014306OtherBLUE SHIELD OF IDAHO
CA008=========00OtherLIBERTY MUTUAL
UT32473OtherDESERET MUTUAL DENEFIT
UT=========OtherUNITED HEALTHCARE
WI========= 83330 0000OtherTRI CARE
ID002809000Medicaid
WV=========OtherASSURANT HEALTH
ID1508062Medicare ID - Type Unspecified