Organization
WORLEY AMBULANCE ASSOCIATION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHARLENE E. WADDELL (BUSINESS MANAGER)
(208) 686-1883
Entity
Organization
Contact information
Practice address
9816 I STREET, WORLEY, ID 83876
(208) 686-1883
(208) 686-3604
Mailing address
PO BOX 69, WORLEY, ID 83876-0069
(208) 686-1883
(208) 686-3604
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
7107
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010014312
REGENCE BLUE SHIELD OF ID
ID
05
—
002508500
—
ID
01
—
E0393
BLUE CROSS OF IDAHO
ID
Enumeration date
09/20/2005
Last updated
11/01/2011
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