Canyon County Ambulance District
Organization Active NPI Ambulance · Caldwell, ID
NPI 1114926151 · NPPES record last updated Dec 18, 2012
Key facts
- NPI
- 1114926151
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulance 341600000X
- License
- 7479 (ID)
- Legal business name
- CANYON COUNTY AMBULANCE DISTRICT
- Practice address
- 6116 Graye Lane
Caldwell, ID 83607-8072 - Phone
- (208) 795-6920
- Fax
- (208) 795-6921
- NPI assigned
- Jul 20, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Greg D Owen
- Title
- Director
- Phone
- (208) 795-6920
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 13D1098212 | Canyon County Ambulance District | Certificate of waiver | Apr 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080520000190 | ID | Part B Supplier - Ambulance Service Supplier | 8224107081 | Practice locations: Nampa, ID; Wilder, ID; Middleton, ID; Caldwell, ID |
National Provider Directory
Locations
310 S 7th Ave
Caldwell, ID 83605
6116 Graye Ln
Caldwell, ID 83607
Phone (208) 795-6930
920 Specht Ave
Caldwell, ID 83605
1920 Ellis Ave
Caldwell, ID 83605
11118 Moss Ln
Nampa, ID 83651
Phone (208) 563-5910
1222 N Midland Blvd
Nampa, ID 83651
Phone (208) 795-6930
601 Patriot Way
Wilder, ID 83676
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 7479 | ID | Yes |
| Land Ambulance | 3416L0300X | 8301 | ID |
Addresses
Primary practice location
6116 Graye Lane
Caldwell, ID 83607-8072
Mailing address
6116 Graye Lane
Caldwell, ID 83607-8072
Phone (208) 795-6920
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010014692 | Other | ID | BLUE SHIELD OF IDAHO |
| 5816 | Other | ID | UPR EMPLOYEE HEALTH SYST |
| E007-0 | Other | DE | BLUE CROSS OF IDAHO |
| 002623200 | Medicaid | ID |
Other providers in Caldwell, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.