Provider Demographics
NPI:1487764551
Name:CUSTER COUNTY
Entity type:Organization
Organization Name:CUSTER COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD OF CUSTER COU
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-879-2360
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:CHALLIS
Mailing Address - State:ID
Mailing Address - Zip Code:83226
Mailing Address - Country:US
Mailing Address - Phone:208-879-2360
Mailing Address - Fax:406-542-2785
Practice Address - Street 1:202 MCCALEB STREET
Practice Address - Street 2:
Practice Address - City:MACKAY
Practice Address - State:ID
Practice Address - Zip Code:83251
Practice Address - Country:US
Practice Address - Phone:208-588-2603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID77123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002504700Medicaid
IDE0609OtherBCBS
1505579Medicare ID - Type Unspecified
=========Medicare UPIN