NPI 1083614036
Blaine County
Practice location
- Address
- 480 E Avenue N, Ketchum, ID 83340
- Phone
- (208) 788-5505
- Mailing address
- 206 S 1st Ave Suite 200, Hailey, ID 83333-8429
Authorised official
- Name
- Jolynn Drage
- Title
- Clerk, Auditor and Recorder
- Phone
- (208) 788-5505
Registered specialties
Land Ambulance
Primary
Registry record
- NPI
- 1083614036
- Entity type
- Organization
- NPI issued
- 29 Jul 2005
- Record last updated
- 17 Dec 2019
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.