| Organization Name: | MOOSE MOUNTAIN SERVICES |
| NPI Number: | 1730484304 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JESSE JACKSON (OWNER) |
| Mailing Address: | 3200 Great Northern Rd Sandpoint |
| State: | ID US |
| Postal Code: | 838649214 |
| Phone Number: | 7703758176 |
| Fax Number: | |
| NPI Enumeration Date: | 01/12/2011 |
| NPI Last Update Date: | 01/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 343900000X |
| License Number: | D144385 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Non-emergency Medical Transport (VAN) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations. |