Organization
CLARK FORK VALLEY AMBULANCE SERVICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEE MILLER (DIRECTOR & ACCTS REC'BLE OFFICER)
(208) 610-3164
Entity
Organization
Contact information
Practice address
111 EAST 2ND, CLARK FORK, ID 83811-0464
(208) 266-1161
(208) 266-0219
Mailing address
PO BOX 464, CLARK FORK, ID 83811-0464
(208) 266-1161
(208) 266-0219
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
6103
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002459300
—
ID
01
—
1504745
PTAN
ID
Enumeration date
08/03/2005
Last updated
02/28/2017
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