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General NPI Number Information
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NPI Number | 1306739107
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Entity Type | Organization
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Legal Business Name | SNAKE RIVER RIDES, LLC.
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 1160 E 3600 N
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City | BUHL
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State | ID
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Zip | 83316-6202
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Country | US
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Telephone | 208-608-3998
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 384
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City | BUHL
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State | ID
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Zip | 83316-0384
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Country | US
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Telephone | 208-608-3998
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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. ISAAC B. MOFFETT
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Credential |
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Telephone | 208-608-3998
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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 |
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