Provider Demographics
NPI:1063688158
Name:SMOUT, CHARLENE M
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:M
Last Name:SMOUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:293 N YELLOWSTONE HWY
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-0096
Mailing Address - Country:US
Mailing Address - Phone:208-521-7002
Mailing Address - Fax:
Practice Address - Street 1:293 N YELLOWSTONE HWY
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5661
Practice Address - Country:US
Practice Address - Phone:208-521-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)