Provider Demographics
NPI:1205925435
Name:LEADORE EMERGENCY MEDICAL TECHNICIANS, INC.
Entity type:Organization
Organization Name:LEADORE EMERGENCY MEDICAL TECHNICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-768-2714
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:LEADORE
Mailing Address - State:ID
Mailing Address - Zip Code:83464-0051
Mailing Address - Country:US
Mailing Address - Phone:208-768-2426
Mailing Address - Fax:208-768-2426
Practice Address - Street 1:117 GALENA ST.
Practice Address - Street 2:
Practice Address - City:LEADORE
Practice Address - State:ID
Practice Address - Zip Code:83464-0051
Practice Address - Country:US
Practice Address - Phone:208-768-2426
Practice Address - Fax:208-768-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5706341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010033120OtherREGENCE BLUE SHIELD
OK200070010AMedicaid
ID002494700Medicaid
IDE0682OtherBLUE CROSS OF IDAHO
MT0442323Medicaid
OK200070010AMedicaid