Organization
MUDLAKE AMBULANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA WEBSTER (TREASURER)
(208) 716-2369
Entity
Organization
Contact information
Practice address
1055 EAST 1100 NORTH, TERRETON, ID 83450
(208) 716-2369
Mailing address
PO BOX 3362, IDAHO FALLS, ID 83403-3362
(208) 525-2090
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
7714
ID
Other
Enumeration date
11/03/2006
Last updated
07/10/2007
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