Provider Demographics
NPI:1699879304
Name:CITY OF KAMIAH
Entity type:Organization
Organization Name:CITY OF KAMIAH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE AUDITOR
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:KILLMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-628-3420
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3510
Mailing Address - Country:US
Mailing Address - Phone:360-394-7020
Mailing Address - Fax:360-394-7099
Practice Address - Street 1:515 MAIN ST
Practice Address - Street 2:
Practice Address - City:KAMIAH
Practice Address - State:ID
Practice Address - Zip Code:83536-0338
Practice Address - Country:US
Practice Address - Phone:208-935-2672
Practice Address - Fax:208-935-0697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID#72023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0028062Medicaid
ID9000704OtherWASHINGTON MEDICAID
ID000010014334OtherBLUE SHIELD
ID590005822OtherRAILROAD MEDICARE
IDE010-4OtherBLUE CROSS
ID0028062Medicaid