Organization
CANYON COUNTY AMBULANCE DISTRICT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG D OWEN (DIRECTOR)
(208) 795-6920
Entity
Organization
Contact information
Practice address
6116 GRAYE LANE, CALDWELL, ID 83607-8072
(208) 795-6920
(208) 795-6921
Mailing address
6116 GRAYE LANE, CALDWELL, ID 83607-8072
(208) 795-6920
(208) 795-6921
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
7479
ID
3416L0300X
Land Ambulance
8301
ID
Other
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
Enumeration date
07/20/2005
Last updated
12/18/2012
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