Healthcare Provider Details

I. General information

NPI: 1306739107
Provider Name (Legal Business Name): SNAKE RIVER RIDES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 E 3600 N
BUHL ID
83316-6202
US

IV. Provider business mailing address

PO BOX 384
BUHL ID
83316-0384
US

V. Phone/Fax

Practice location:
  • Phone: 208-608-3998
  • Fax:
Mailing address:
  • Phone: 208-608-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. ISAAC B. MOFFETT
Title or Position: OWNER
Credential:
Phone: 208-608-3998