Organization
CROUCH VOLUNTEER AMBULANCE SERVICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN C. METZ EMT-P (VICE PRESIDENT)
(208) 243-4059
Entity
Organization
Contact information
Practice address
854 BANKS-LOWMAN RD, GARDEN VALLEY, ID 83622
(208) 462-2307
Mailing address
854 BANKS-LOWMAN RD, GARDEN VALLEY, ID 83622
(208) 462-2307
Taxonomy
Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
5404
ID
3416L0300X
Land Ambulance
Primary
5404
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002807500
—
ID
01
—
E 01611
BLUE CROSS
ID
Enumeration date
01/16/2007
Last updated
06/12/2014
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