# COUNCIL VALLEY AMBULANCE

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

## Provider details

- **NPI number:** 1861558868
- **Authorized official:** MR. DAN L HUTER EMT (PRESIDENT)
- **Authorized official phone:** (208) 253-4560

## Contact information

- **Practice address:** 205 N BERKLEY, COUNCIL, ID 83612-0390
- **Practice address phone:** (208) 253-4778
- **Practice address fax:** (208) 253-4778
- **Mailing address:** 205 N BERKLEY, PO BOX 390, COUNCIL, ID 83612-0390
- **Mailing address phone:** (208) 253-4778
- **Mailing address fax:** (208) 253-4778

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 5310 | ID | Yes |

## Other

- **Enumeration date:** 12/28/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00010014291 | BLUE SHIELD | ID |
| 01 | — | E0153 | BLUE CROSS | ID |