Provider Demographics
NPI:1861558868
Name:COUNCIL VALLEY AMBULANCE
Entity type:Organization
Organization Name:COUNCIL VALLEY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUTER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:208-253-4560
Mailing Address - Street 1:205 N BERKLEY
Mailing Address - Street 2:PO BOX 390
Mailing Address - City:COUNCIL
Mailing Address - State:ID
Mailing Address - Zip Code:83612-0390
Mailing Address - Country:US
Mailing Address - Phone:208-253-4778
Mailing Address - Fax:208-253-4778
Practice Address - Street 1:205 N BERKLEY
Practice Address - Street 2:
Practice Address - City:COUNCIL
Practice Address - State:ID
Practice Address - Zip Code:83612-0390
Practice Address - Country:US
Practice Address - Phone:208-253-4778
Practice Address - Fax:208-253-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5310341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDE0153OtherBLUE CROSS
ID00010014291OtherBLUE SHIELD
ID1504891Medicare ID - Type Unspecified