Provider Demographics
NPI:1336214204
Name:TRI MED
Entity type:Organization
Organization Name:TRI MED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAURE
Authorized Official - Suffix:
Authorized Official - Credentials:ATC L EMT
Authorized Official - Phone:208-241-2487
Mailing Address - Street 1:13279 N MOONGLOW LN
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5122
Mailing Address - Country:US
Mailing Address - Phone:208-241-2487
Mailing Address - Fax:
Practice Address - Street 1:13279 N MOONGLOW LN
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83202-5122
Practice Address - Country:US
Practice Address - Phone:208-241-2487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID46233416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport