# IDAHO MEDICAL TRANSPORT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265682694
- **Authorized official:** MARSHEL BYRON PRUIETT (MANAGING MEMBER)
- **Authorized official phone:** (208) 777-7719

## Contact information

- **Practice address:** 1924 E PREAKNESS AVE, COEUR D ALENE, ID 83815-9428
- **Practice address phone:** (208) 777-7719
- **Mailing address:** 1924 E PREAKNESS AVE, COEUR D ALENE, ID 83815-9428
- **Mailing address phone:** (208) 777-7719

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | — | ID | Yes |

## Other

- **Enumeration date:** 09/23/2008
- **Last updated:** 09/23/2008