Organization
MEADOW VALLEY AMBULANCE SERVICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB MAC QUALLS (EMS CHIEF)
(208) 469-0005
Entity
Organization
Contact information
Practice address
200 HWY 95, NEW MEADOWS, ID 83654
(208) 347-3190
Mailing address
PO BOX 532, NEW MEADOWS, ID 83654-0532
(208) 469-0005
(208) 347-3190
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
#5313
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010014875
BLUE SHIELD
ID
05
—
8050189
—
ID
01
—
E5319
BLUE CROSS
ID
01
—
P00132573
RAILROAD MEDICARE
ID
Enumeration date
09/12/2006
Last updated
01/18/2013
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