Provider Demographics
NPI:1316465453
Name:COUNTY OF ELMORE
Entity type:Organization
Organization Name:COUNTY OF ELMORE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ALKIRE
Authorized Official - Suffix:
Authorized Official - Credentials:CAC
Authorized Official - Phone:208-580-0413
Mailing Address - Street 1:150 S 4TH E STE 3
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-3000
Mailing Address - Country:US
Mailing Address - Phone:208-587-2129
Mailing Address - Fax:208-587-2159
Practice Address - Street 1:150 S 4TH E STE 3
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-3000
Practice Address - Country:US
Practice Address - Phone:208-587-2133
Practice Address - Fax:208-587-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID10020OtherAGENCY LICENSE
ID7511Medicaid