1306299151 NPI number — EAGLES WINGS TRANSPORTATION

Table of content: (NPI 1306299151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306299151 NPI number — EAGLES WINGS TRANSPORTATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAGLES WINGS TRANSPORTATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306299151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 209
Provider Second Line Business Mailing Address:
199 VALLEY COURT
Provider Business Mailing Address City Name:
CHALLIS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83226-0209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-507-4185
Provider Business Mailing Address Fax Number:
208-879-2516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
199 VALLEY COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHALLIS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-507-4185
Provider Business Practice Location Address Fax Number:
208-879-2516
Provider Enumeration Date:
07/18/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COATES
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
SOLE PROPRIETOR/OWNER
Authorized Official Telephone Number:
503-507-4185

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)