Organization
TRI MED
Active
Other names
AMBULANCE SPORTS MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENT M FAURE ATC L EMT (OWNER)
(208) 241-2487
Entity
Organization
Contact information
Practice address
13279 N MOONGLOW LN, POCATELLO, ID 83202-5122
(208) 241-2487
Mailing address
13279 N MOONGLOW LN, POCATELLO, ID 83202-5122
(208) 241-2487
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
4623
ID
Other
Enumeration date
11/23/2006
Last updated
08/22/2020
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