Provider Demographics
NPI:1548702178
Name:BURKE NON-EMERGENCY MEDICAL TRANSPORT, LLC
Entity type:Organization
Organization Name:BURKE NON-EMERGENCY MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-876-0170
Mailing Address - Street 1:451 E 8750 S
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-4602
Mailing Address - Country:US
Mailing Address - Phone:770-876-0170
Mailing Address - Fax:
Practice Address - Street 1:451 E 8750 S
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-4602
Practice Address - Country:US
Practice Address - Phone:770-876-0170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)