Provider Demographics
NPI:1326498981
Name:IDAHO TRANSPORTATION COMPANY, INC
Entity Type:Organization
Organization Name:IDAHO TRANSPORTATION COMPANY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VLADISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:ARUTYUNOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-206-5000
Mailing Address - Street 1:3520 GREENWILLOW LN
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-2434
Mailing Address - Country:US
Mailing Address - Phone:208-206-5000
Mailing Address - Fax:
Practice Address - Street 1:2055 GARRETT WAY
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5100
Practice Address - Country:US
Practice Address - Phone:208-223-7720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)