Healthcare Provider Details

I. General information

NPI: 1447476551
Provider Name (Legal Business Name): LOST RIVERS EMT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NORTH IDAHO STREET
ARCO ID
83213
US

IV. Provider business mailing address

201 NORTH IDAHO STREET
ARCO ID
83213
US

V. Phone/Fax

Practice location:
  • Phone: 208-527-3046
  • Fax:
Mailing address:
  • Phone: 208-527-3046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number7707
License Number StateID

VIII. Authorized Official

Name: BOB MOZES
Title or Position: EMT
Credential:
Phone: 208-527-3046