Prairie Transportation 1 LLC

Primary specialty

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

Legal business name

PRAIRIE TRANSPORTATION 1 LLC

Practice address

2706 Grelle Ave
Lewiston, ID 83501-9742

Phone

(208) 798-1508

NPI assigned

Jun 15, 2016

Organization subpart

No

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

Authorized official

Name

Scott Bagley

Title

Owner

Phone

(208) 717-7179

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465948800000",
    "number": "1841640406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2706 GRELLE AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835019742",
            "telephone_number": "208-798-1508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2706 GRELLE AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835019742",
            "telephone_number": "208-798-1508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE TRANSPORTATION 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-15",
        "last_updated": "2016-06-15",
        "status": "A",
        "authorized_official_last_name": "BAGLEY",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-717-7179"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M0025887",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Pope, LCSW
• Andre Popich
• Charles Pottenger, PHARMD
• Alicia Flynne Powell, MSW
• Prairie Home Care LLC
• Provident Foundation - Wedgewood Terrace LLC
• Amy Puhl, RN
• Radiation Oncology Associates, PLLC
• Rohan Srihari Raghuram
• Kelsey Kirsten Rahe, DMD

• Non-emergency Medical Transport (VAN) in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Non-emergency Medical Transport (VAN) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; 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.