Custer County

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

7712 Issued in ID

Legal business name

CUSTER COUNTY

Doing business as

South Custer Ambulance

Practice address

202 McCaleb Street
Mackay, ID 83251

Phone

(208) 588-2603

NPI assigned

Aug 30, 2006

Last updated

Jun 13, 2023By 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

Wayne Butts

Title

Chairman of the Board of Custer Cou

Phone

(208) 879-2360

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• South Custer Ambulance Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686614400000",
    "number": "1487764551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 385",
            "city": "CHALLIS",
            "state": "ID",
            "postal_code": "83226",
            "telephone_number": "208-879-2360",
            "fax_number": "406-542-2785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 MCCALEB STREET",
            "city": "MACKAY",
            "state": "ID",
            "postal_code": "83251",
            "telephone_number": "208-588-2603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTER COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A",
        "authorized_official_last_name": "BUTTS",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "CHAIRMAN OF THE BOARD OF CUSTER COU",
        "authorized_official_telephone_number": "208-879-2360"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "ID",
            "license": "7712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002504700",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "E0609",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Custer Ambulance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; 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.