# CANYON COUNTY AMBULANCE DISTRICT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114926151
- **Authorized official:** MR. GREG D OWEN (DIRECTOR)
- **Authorized official phone:** (208) 795-6920

## Contact information

- **Practice address:** 6116 GRAYE LANE, CALDWELL, ID 83607-8072
- **Practice address phone:** (208) 795-6920
- **Practice address fax:** (208) 795-6921
- **Mailing address:** 6116 GRAYE LANE, CALDWELL, ID 83607-8072
- **Mailing address phone:** (208) 795-6920
- **Mailing address fax:** (208) 795-6921

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 7479 | ID | Yes |
| 3416L0300X | Land Ambulance | 8301 | ID | — |

## Other

- **Enumeration date:** 07/20/2005
- **Last updated:** 12/18/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010014692 | BLUE SHIELD OF IDAHO | ID |
| 05 | — | 002623200 | — | ID |
| 01 | — | 5816 | UPR EMPLOYEE HEALTH SYST | ID |
| 01 | — | E007-0 | BLUE CROSS OF IDAHO | DE |