Healthcare Provider Details

I. General information

NPI: 1205925435
Provider Name (Legal Business Name): LEADORE EMERGENCY MEDICAL TECHNICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 GALENA ST.
LEADORE ID
83464-0051
US

IV. Provider business mailing address

PO BOX 51
LEADORE ID
83464-0051
US

V. Phone/Fax

Practice location:
  • Phone: 208-768-2426
  • Fax: 208-768-2426
Mailing address:
  • Phone: 208-768-2426
  • Fax: 208-768-2426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number5706
License Number StateID

VIII. Authorized Official

Name: MR. RICHARD SNYDER
Title or Position: PRESIDENT
Credential:
Phone: 208-768-2714