Healthcare Provider Details

I. General information

NPI: 1104744242
Provider Name (Legal Business Name): PALOUSE MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10403 DUNE LAKE LOOP SE
MOSES LAKE WA
98837-9083
US

IV. Provider business mailing address

5951 PULLMAN AIRPORT RD
PULLMAN WA
99163
US

V. Phone/Fax

Practice location:
  • Phone: 509-635-7433
  • Fax:
Mailing address:
  • Phone: 509-635-7433
  • 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: STACIE PACK
Title or Position: OWNER
Credential:
Phone: 509-635-7433