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General NPI Number Information
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NPI Number | 1457104614
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Entity Type | Organization
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Legal Business Name | IDAHO EXPRESS TRANSPORTATION LLC
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 540 W HIGHWAY 26
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City | BLACKFOOT
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State | ID
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Zip | 83221-5592
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Country | US
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Telephone | 775-691-3809
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Fax |
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Provider Business Mailing Address
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Address Line | 2080 BORRESON ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-5859
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Country | US
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Telephone | 775-691-3809
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. YUNG D GERMAN
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Credential | CPR
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Telephone | 775-691-3809
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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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