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General NPI Number Information
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NPI Number | 1295276590
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Entity Type | Organization
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Legal Business Name | EAGLES WINGS TRANSPORTATION
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 199 VALLEY CT
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City | CHALLIS
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State | ID
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Zip | 83226
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Country | US
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Telephone | 503-507-4185
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 209
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City | CHALLIS
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State | ID
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Zip | 83226-0209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | KIMBERLY R COATES
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Credential |
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Telephone | 503-507-4185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | NS101615A
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License Number State | ID
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