Provider Demographics
NPI:1457104614
Name:IDAHO EXPRESS TRANSPORTATION LLC
Entity Type:Organization
Organization Name:IDAHO EXPRESS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YUNG
Authorized Official - Middle Name:D
Authorized Official - Last Name:GERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPR
Authorized Official - Phone:775-691-3809
Mailing Address - Street 1:2080 BORRESON ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-5859
Mailing Address - Country:US
Mailing Address - Phone:775-691-3809
Mailing Address - Fax:
Practice Address - Street 1:540 W HIGHWAY 26
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-5592
Practice Address - Country:US
Practice Address - Phone:775-691-3809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)