Provider Demographics
NPI:1104181791
Name:SHOSHONE PAIUTE TRIBES
Entity Type:Organization
Organization Name:SHOSHONE PAIUTE TRIBES
Other - Org Name:OWYHEE AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-757-2403
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:OWYHEE
Mailing Address - State:NV
Mailing Address - Zip Code:89832-0130
Mailing Address - Country:US
Mailing Address - Phone:775-757-2403
Mailing Address - Fax:
Practice Address - Street 1:1623 HOSPITAL LOOP ROAD
Practice Address - Street 2:
Practice Address - City:OWYHEE
Practice Address - State:NV
Practice Address - Zip Code:89832-9800
Practice Address - Country:US
Practice Address - Phone:775-757-2403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport