Potlatch Rural Fire Dist

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

7206 Issued in ID

Legal business name

POTLATCH RURAL FIRE DIST

Practice address

512 Pine Street
Potlatch, ID 83855

Phone

(208) 875-0139

NPI assigned

Aug 24, 2007

Last updated

Oct 20, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vivian L Coy

Title

Ambulance Commissioner

Phone

(208) 875-0139

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255996800000",
    "number": "1053504829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 63",
            "city": "POTLATCH",
            "state": "ID",
            "postal_code": "838550063",
            "telephone_number": "208-875-0139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 PINE STREET",
            "city": "POTLATCH",
            "state": "ID",
            "postal_code": "83855",
            "telephone_number": "208-875-0139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTLATCH RURAL FIRE DIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-24",
        "last_updated": "2009-10-20",
        "status": "A",
        "authorized_official_last_name": "COY",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "AMBULANCE COMMISSIONER",
        "authorized_official_telephone_number": "208-875-0139"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "ID",
            "license": "7206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "15003721",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northwest Pharmacy Services Inc (Northwest Pharmacy)
• Northwest Pharmacy Services, Inc.
• Palouse Ridge Occupational Therapy PLLC
• Suzanne Paul, M.D.
• Potlatch Family Dental, PC
• Anne M White, LICSW
• Skyler S Worthington, PA-C

• Land Ambulance in Potlatch, ID
• Providers in Potlatch, ID by specialty
• Land Ambulance in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.