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General NPI Number Information
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NPI Number | 1205925435
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Entity Type | Organization
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Legal Business Name | LEADORE EMERGENCY MEDICAL TECHNICIANS, INC.
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 117 GALENA ST.
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City | LEADORE
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State | ID
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Zip | 83464-0051
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Country | US
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Telephone | 208-768-2426
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Fax | 208-768-2426
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Provider Business Mailing Address
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Address Line | PO BOX 51
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City | LEADORE
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State | ID
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Zip | 83464-0051
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Country | US
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Telephone | 208-768-2426
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Fax | 208-768-2426
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD SNYDER
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Credential |
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Telephone | 208-768-2714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 5706
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License Number State | ID
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