Provider Demographics
NPI:1275984098
Name:ALL-CITY TRANSPPRT
Entity Type:Organization
Organization Name:ALL-CITY TRANSPPRT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARAMEDIC
Authorized Official - Prefix:
Authorized Official - First Name:JAXON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-866-2089
Mailing Address - Street 1:PO BOX 190513
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2399 S ORCHARD ST
Practice Address - Street 2:#213
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-3793
Practice Address - Country:US
Practice Address - Phone:208-866-1038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)