Organization
PRAIRIE TRANSPORTATION 1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT BAGLEY (OWNER)
(208) 717-7179
Entity
Organization
Contact information
Practice address
2706 GRELLE AVE, LEWISTON, ID 83501-9742
(208) 798-1508
Mailing address
2706 GRELLE AVE, LEWISTON, ID 83501-9742
(208) 798-1508
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M0025887
—
ID
Enumeration date
06/15/2016
Last updated
06/15/2016
Update your record
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