Organization
MOOSE MOUNTAIN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSE JACKSON (OWNER)
(208) 290-6726
Entity
Organization
Contact information
Practice address
3200 GREAT NORTHERN RD, SANDPOINT, ID 83864-9214
(770) 375-8176
Mailing address
3200 GREAT NORTHERN RD, SANDPOINT, ID 83864-9214
(770) 375-8176
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
D144385
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110120030
—
ID
Enumeration date
01/12/2011
Last updated
01/12/2011
Update your record
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