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Shoshone County Ambulance Service District

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Company Details

Name: Shoshone County Ambulance Service District
Jurisdiction: Idaho
Legal type: Unincorporated Nonprofit Association (D)
Status: Active-Current
Date of registration: 21 Nov 2023 (2 years ago)
Entity Number: 5485005
Place of Formation: IDAHO
File Number: 908397
ZIP code: 83837
County: Shoshone County
Principal Address: 911 BUNKER AVE. KELLOGG, ID 83837
Mailing Address: PO BOX 488 OSBURN, ID 83849-0488

Agent

Name Role Address
Scott Dietrich Agent 911 BUNKER AVE, KELLOGG, ID 83837

Unique Entity ID

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

Unique Entity ID:
JEJUDENPCYY5
CAGE Code:
909S2
UEI Expiration Date:
2026-04-21

Business Information

Division Name:
SHOSHONE COUNTY AMBULANCE SERVICE DISTRICT
Division Number:
SHOSHONE C
Activation Date:
2025-04-22
Initial Registration Date:
2021-04-28

National Provider Identifier

NPI Number:
1174130074
Certification Date:
2020-09-23

Authorized Person:

Name:
MR. JERRY JOHN BRANTZ
Role:
SECRETARY/TREASURER - BOARD MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
341600000X - Ambulance
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0005485005 2023-11-21

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Date of last update: 22 May 2025

Sources: Idaho Secretary of State