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Organization

IDAHO MEDICAL TRANSPORT

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARSHEL BYRON PRUIETT (MANAGING MEMBER)
(208) 777-7719
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
ID

Other

Enumeration date
09/23/2008
Last updated
09/23/2008
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