Provider Demographics
NPI:1104978535
Name:CAMBRIDGE VOLUNTEER FIRE DEPT INC
Entity type:Organization
Organization Name:CAMBRIDGE VOLUNTEER FIRE DEPT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:JAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-566-3244
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:ID
Mailing Address - Zip Code:83610-0187
Mailing Address - Country:US
Mailing Address - Phone:208-257-3763
Mailing Address - Fax:208-257-3763
Practice Address - Street 1:190 N COMMERCIAL
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:ID
Practice Address - Zip Code:83610
Practice Address - Country:US
Practice Address - Phone:208-257-3763
Practice Address - Fax:208-257-3763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4311341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDE0856OtherBLUE CROSS
ID8071768Medicaid
ID1522169Medicare PIN
ID8071768Medicaid