Provider Demographics
NPI:1649621525
Name:WHITE TAIL TRANSPORTATION, INC.
Entity type:Organization
Organization Name:WHITE TAIL TRANSPORTATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-682-4424
Mailing Address - Street 1:PO BOX 2124
Mailing Address - Street 2:
Mailing Address - City:PRIEST RIVER
Mailing Address - State:ID
Mailing Address - Zip Code:83856-2124
Mailing Address - Country:US
Mailing Address - Phone:208-448-0848
Mailing Address - Fax:208-448-0846
Practice Address - Street 1:5486 HIGHWAY 2 STE 102
Practice Address - Street 2:
Practice Address - City:PRIEST RIVER
Practice Address - State:ID
Practice Address - Zip Code:83856-6072
Practice Address - Country:US
Practice Address - Phone:208-448-0848
Practice Address - Fax:208-448-0846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)