Organization
CUSTER COUNTY
Active
Other names
South Custer Ambulance
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE BUTTS (CHAIRMAN OF THE BOARD OF CUSTER COU)
(208) 879-2360
Entity
Organization
Contact information
Practice address
202 MCCALEB STREET, MACKAY, ID 83251
(208) 588-2603
Mailing address
PO BOX 385, CHALLIS, ID 83226
(208) 879-2360
(406) 542-2785
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
7712
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002504700
—
ID
01
—
E0609
BCBS
ID
Enumeration date
08/30/2006
Last updated
06/13/2023
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