MEDICARE: MOUNTAIN WEST INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	2301L	UT
2	3416L0300X	Land Ambulance	05326	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972500445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN WEST INC

Provider Business Mailing Address
First Line	:	PO BOX 2530
Second Line	:
City	:	WEST WENDOVER
State	:	NV
Zip	:	89883-2530
Country	:	US
Telephone Number	:	775-664-2081
Fax Number	:	775-664-2244

Provider Business Practice Location Address
First Line	:	427 MESA
Second Line	:
City	:	WEST WENDOVER
State	:	NV
Zip	:	89883-2530
Country	:	US
Telephone Number	:	775-664-2081
Fax Number	:	775-664-2244

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LAUARA ANN SNYDER
Credential	:
Telephone Number	:	775-664-2081

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/27/2011

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Directions to “MOUNTAIN WEST INC ” Practice Location

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