Provider Demographics
NPI:1790064517
Name:ACUTE RESCUE AND TRANSPORT, INC
Entity Type:Organization
Organization Name:ACUTE RESCUE AND TRANSPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-965-8072
Mailing Address - Street 1:6055 W CORPORAL LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9315
Mailing Address - Country:US
Mailing Address - Phone:208-965-8072
Mailing Address - Fax:208-965-8074
Practice Address - Street 1:6055 W CORPORAL LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9315
Practice Address - Country:US
Practice Address - Phone:208-965-8072
Practice Address - Fax:208-965-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6800341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA0000846Medicaid