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General NPI Number Information
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NPI Number | 1326707498
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Entity Type | Organization
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Legal Business Name | SHUDL LLC
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 343 N 10TH AVE
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City | POCATELLO
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State | ID
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Zip | 83201-5254
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Country | US
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Telephone | 208-240-3480
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Fax |
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Provider Business Mailing Address
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Address Line | 343 N 10TH AVE
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City | POCATELLO
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State | ID
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Zip | 83201-5254
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Country | US
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Telephone | 208-240-3480
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JESSIE M REDD
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Credential |
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Telephone | 208-240-3480
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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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