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General NPI Number Information
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NPI Number | 1316793128
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Entity Type | Organization
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Legal Business Name | ASCENT MEDICAL TRANSPORT, LLC
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Dates
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Enumeration Date | 04/24/2024
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 11880 W PRESIDENT DR STE A
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City | BOISE
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State | ID
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Zip | 83713-8960
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Country | US
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Telephone | 208-781-0875
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Fax |
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Provider Business Mailing Address
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Address Line | 11880 W PRESIDENT DR STE A
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City | BOISE
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State | ID
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Zip | 83713-8960
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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 | CHIEF EXECUTIVE OFFICER
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Name | MATTHEW KAISERMAN
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Credential |
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Telephone | 208-781-0875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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