Provider Demographics
NPI:1306299151
Name:EAGLES WINGS TRANSPORTATION
Entity type:Organization
Organization Name:EAGLES WINGS TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-507-4185
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:199 VALLEY COURT
Mailing Address - City:CHALLIS
Mailing Address - State:ID
Mailing Address - Zip Code:83226-0209
Mailing Address - Country:US
Mailing Address - Phone:503-507-4185
Mailing Address - Fax:208-879-2516
Practice Address - Street 1:199 VALLEY COURT
Practice Address - Street 2:
Practice Address - City:CHALLIS
Practice Address - State:ID
Practice Address - Zip Code:83226
Practice Address - Country:US
Practice Address - Phone:503-507-4185
Practice Address - Fax:208-879-2516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)