| Organization Name: | MINIDOKA MEMORIAL HOSPITAL AMBULANCE |
| NPI Number: | 1225202922 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARL HANSEN (ADMINISTRATOR) |
| Mailing Address: | 1224 8th St Rupert |
| State: | ID US |
| Postal Code: | 833501527 |
| Phone Number: | 2084360481 |
| Fax Number: | 2084348675 |
| NPI Enumeration Date: | 04/15/2008 |
| NPI Last Update Date: | 06/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |