Crouch Volunteer Ambulance Service, Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

5404 Issued in ID

Legal business name

CROUCH VOLUNTEER AMBULANCE SERVICE, INC

Practice address

854 Banks-Lowman Rd
Garden Valley, ID 83622

Phone

(208) 462-2307

NPI assigned

Jan 16, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Jonathan C. Metz, EMT-P

Title

Vice President

Phone

(208) 243-4059

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402531200000",
    "number": "1932250651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "854 BANKS-LOWMAN RD",
            "city": "GARDEN VALLEY",
            "state": "ID",
            "postal_code": "83622",
            "telephone_number": "208-462-2307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "854 BANKS-LOWMAN RD",
            "city": "GARDEN VALLEY",
            "state": "ID",
            "postal_code": "83622",
            "telephone_number": "208-462-2307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROUCH VOLUNTEER AMBULANCE SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2014-06-12",
        "status": "A",
        "authorized_official_last_name": "METZ",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "208-243-4059",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "EMT-P"
    },
    "taxonomies": [
        {
            "code": "146M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medical Technician, Intermediate",
            "state": "ID",
            "license": "5404",
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "ID",
            "license": "5404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "E 01611",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002807500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teliesha Batuik, MSW
• Martha Bollich, MS OTR/L
• Benjamin Dean Brown, PA-C
• County of Boise 71 Garden Valley
• Sharon Lynne Cranston
• DJ Garden Valley Pharmacy (Medicap Pharmacy 8427)
• DJ Garden Valley Pharmacy Inc (Medicap Pharmacy #8427)
• Garden Valley Family Medicine PC
• Garden Valley Fire Protection
• Michael R Koenig, MD

• Land Ambulance in Garden Valley, ID
• Providers in Garden Valley, 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 12, 2014; 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.