Organization
POTLATCH RURAL FIRE DIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIVIAN L COY (AMBULANCE COMMISSIONER)
(208) 875-0139
Entity
Organization
Contact information
Practice address
512 PINE STREET, POTLATCH, ID 83855
(208) 875-0139
Mailing address
PO BOX 63, POTLATCH, ID 83855-0063
(208) 875-0139
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
7206
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15003721
MEDICARE PTAN
ID
Enumeration date
08/24/2007
Last updated
10/20/2009
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