Provider Demographics
NPI:1730281064
Name:CLEARWATER COUNTY
Entity type:Organization
Organization Name:CLEARWATER COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LES
Authorized Official - Middle Name:
Authorized Official - Last Name:EAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-476-3771
Mailing Address - Street 1:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-1347
Mailing Address - Country:US
Mailing Address - Phone:208-476-3771
Mailing Address - Fax:208-476-3155
Practice Address - Street 1:1195 RIVERSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544
Practice Address - Country:US
Practice Address - Phone:208-476-3771
Practice Address - Fax:208-476-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID72193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID756590508OtherRAILROAD MEDICARE
ID000010014651OtherREGENCE
ID002808400Medicaid
ID191027OtherREGENCE NORTHWEST HEALTH
ID000010014651OtherBLUE CROSS FEDERAL EMPLOY
IDE0690OtherBLUE CROSS OF IDAHO
ID002808400Medicaid