Moose Mountain Services

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

License

D144385 Issued in ID

Legal business name

MOOSE MOUNTAIN SERVICES

Practice address

3200 Great Northern Rd
Sandpoint, ID 83864-9214

Phone

(770) 375-8176

NPI assigned

Jan 12, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jesse Jackson

Title

Owner

Phone

(208) 290-6726

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294790400000",
    "number": "1730484304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 GREAT NORTHERN RD",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838649214",
            "telephone_number": "770-375-8176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 GREAT NORTHERN RD",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838649214",
            "telephone_number": "770-375-8176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOOSE MOUNTAIN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-12",
        "last_updated": "2011-01-12",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-290-6726"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "ID",
            "license": "D144385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110120030",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monarch Transitions
• Carol Lynne Montegary, NP
• Andrea Moore, O.D.
• Julia Elaine Moore, LPC
• Kathleen M Moore, PSY.D
• David Scott Moran, FNP-C
• Delaney Morehouse, N.D.
• Casandra Morelli
• Angella Rae Morlen
• Robin Morrell, L.M.S.W.

• All providers in Sandpoint, ID
• Non-emergency Medical Transport (VAN) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.