Basic Information
| Provider Information | |||||||||
| NPI: | 1184754053 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAGIC VALLEY PARAMEDICS , LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 367 | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833030367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088147459 | ||||||||
| FaxNumber: | 2088147491 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 MARTIN ST | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833014532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087372298 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 09/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | ANGLE | ||||||||
| AuthorizedOfficialFirstName: | JIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2087372101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | ID | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 000010149121 | 01 | ID | BLUE SHIELD PROV NUMBER | OTHER | P00719362 | 01 | MEDICARE RR | OTHER | 807075100 | 05 | ID | MEDICAID | E1144 | 01 | ID | BLUE CROSS PROV NUMBER | OTHER |