NPIMap

Organization Active NPI

Clark Fork Valley Ambulance Service, Inc.

  • Land Ambulance
  • Clark Fork, ID
National Provider Identifier
1841291630
Registry record updated Feb 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
6103 Issued in ID
Legal business name
CLARK FORK VALLEY AMBULANCE SERVICE, INC.
Practice address
111 East 2ND
Clark Fork, ID 83811-0464
Phone
(208) 266-1161
Fax
(208) 266-0219
NPI assigned
Aug 3, 2005
Last updated
Feb 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2017

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

Authorized official

Name
Mrs. Dee Miller
Title
Director & Accts Rec'Ble Officer
Phone
(208) 610-3164

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 6103 ID Primary

Addresses

Primary practice location

111 East 2ND
Clark Fork, ID 83811-0464

Mailing address

PO Box 464
Clark Fork, ID 83811-0464
Phone (208) 266-1161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120802000740 ID Part B Supplier - Ambulance Service Supplier 0042206427 Practice locations: Clark Fork, ID

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1841291630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 464",
            "city": "CLARK FORK",
            "state": "ID",
            "postal_code": "838110464",
            "telephone_number": "208-266-1161",
            "fax_number": "208-266-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 EAST 2ND",
            "city": "CLARK FORK",
            "state": "ID",
            "postal_code": "838110464",
            "telephone_number": "208-266-1161",
            "fax_number": "208-266-0219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK FORK VALLEY AMBULANCE SERVICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-03",
        "last_updated": "2017-02-28",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "DEE",
        "authorized_official_title_or_position": "DIRECTOR & ACCTS REC'BLE OFFICER",
        "authorized_official_telephone_number": "208-610-3164",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "ID",
            "license": "6103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clark Fork, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; 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.