Worley Ambulance Association, Inc.

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

7107 Issued in ID

Legal business name

WORLEY AMBULANCE ASSOCIATION, INC.

Practice address

9816 I Street
Worley, ID 83876

Phone

(208) 686-1883

Fax

(208) 686-3604

NPI assigned

Sep 20, 2005

Organization subpart

No

Name

Mrs. Charlene E. Waddell

Title

Business Manager

Phone

(208) 686-1883

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 1, 2011.

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320105600000",
    "number": "1720073307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69",
            "city": "WORLEY",
            "state": "ID",
            "postal_code": "838760069",
            "telephone_number": "208-686-1883",
            "fax_number": "208-686-3604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9816 I STREET",
            "city": "WORLEY",
            "state": "ID",
            "postal_code": "83876",
            "telephone_number": "208-686-1883",
            "fax_number": "208-686-3604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WORLEY AMBULANCE ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-20",
        "last_updated": "2011-11-01",
        "status": "A",
        "authorized_official_last_name": "WADDELL",
        "authorized_official_first_name": "CHARLENE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "208-686-1883",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "ID",
            "license": "7107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD OF ID",
            "identifier": "000010014312",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "E0393",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002508500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James R Hathaway, OD
• Dale A Yenney, MSW

• All providers in Worley, ID
• Land Ambulance in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; 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.