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General NPI Number Information
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NPI Number | 1093167058
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Entity Type | Organization
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Legal Business Name | ALL-STAR TRANSPORTATION
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 9422 N 85TH E
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City | IDAHO FALLS
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State | ID
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Zip | 83401-5565
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Country | US
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Telephone | 208-557-4080
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Fax |
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Provider Business Mailing Address
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Address Line | 9422 N 85TH E
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City | IDAHO FALLS
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State | ID
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Zip | 83401-5565
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Country | US
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Telephone | 208-557-4080
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MAUNA RAE H CARLSON
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Credential |
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Telephone | 208-521-2955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | ID
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