Meadow Valley Ambulance Service, Inc.

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

#5313 Issued in ID

Legal business name

MEADOW VALLEY AMBULANCE SERVICE, INC.

Practice address

200 Hwy 95
New Meadows, ID 83654

Phone

(208) 347-3190

NPI assigned

Sep 12, 2006

Last updated

Jan 18, 2013By 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

Jacob Mac Qualls

Title

EMS Chief

Phone

(208) 469-0005

Specialties & licenses 1

Addresses

Other identifiers 4

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358467200000",
    "number": "1689778391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 532",
            "city": "NEW MEADOWS",
            "state": "ID",
            "postal_code": "836540532",
            "telephone_number": "208-469-0005",
            "fax_number": "208-347-3190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HWY 95",
            "city": "NEW MEADOWS",
            "state": "ID",
            "postal_code": "83654",
            "telephone_number": "208-347-3190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOW VALLEY AMBULANCE SERVICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2013-01-18",
        "status": "A",
        "authorized_official_last_name": "QUALLS",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "MAC",
        "authorized_official_title_or_position": "EMS CHIEF",
        "authorized_official_telephone_number": "208-469-0005"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "ID",
            "license": "#5313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010014875",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00132573",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8050189",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "E5319",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenny Iodko, LPC
• Meadows Valley Rural Fire District
• Meadows Valley School Dist #011
• Payette Lakes Medical Clinic, PA
• Rio Peterson, PMHNP
• Catherine Dawn Powers

• Land Ambulance in New Meadows, ID
• Providers in New Meadows, ID by specialty
• Land Ambulance in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.