Organization
MIDVALE FIRE PROTECTION DISTRICT
Active
Other names
Midvale Ambulance
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN GRAHAM (EMS SUPERVISOR)
(208) 550-1605
Entity
Organization
Contact information
Practice address
10 S RIVER STREET, MIDVALE, ID 83645
(208) 550-1605
Mailing address
PO BOX 131, MIDVALE, ID 83645-0131
(208) 550-1605
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
5317
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010014799
BLUE SHIELD
ID
05
—
0024624
—
ID
Enumeration date
04/24/2008
Last updated
04/24/2008
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