Healthcare Provider Details

I. General information

NPI: 1437068178
Provider Name (Legal Business Name): KEVIN SCHAUM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N HIGHWAY 33
DRIGGS ID
83422-4908
US

IV. Provider business mailing address

PO BOX 474
DRIGGS ID
83422-0474
US

V. Phone/Fax

Practice location:
  • Phone: 208-715-5201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number260544
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: