| Organization Name: | CROUCH VOLUNTEER AMBULANCE SERVICE, INC |
| NPI Number: | 1932250651 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JONATHAN C. METZ (VICE PRESIDENT) |
| Mailing Address: | 854 Banks-lowman Rd Garden Valley |
| State: | ID US |
| Postal Code: | 83622 |
| Phone Number: | 2084622307 |
| Fax Number: | |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 06/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 146M00000X |
| License Number: | 5404 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Emergency Medical Service Providers |
| Taxonomy Classification: | Emergency Medical Technician, Intermediate |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An Intermediate EMT is an individual trained and certified to perform intermediate life support treatment in medical emergencies based on individual state boards. |