Organization
NORTHWEST MEDICAL TRANSPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANIECE LAKE (OWNER)
(208) 665-5671
Entity
Organization
Contact information
Practice address
1726 W DEPO DR, HAYDEN, ID 83835-8025
(208) 665-5671
Mailing address
1726 W DEPO DR, HAYDEN, ID 83835-8025
(208) 665-5671
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M8077266
—
ID
Enumeration date
04/27/2016
Last updated
05/06/2026
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