1134257363 NPI number — BLAINE COUNTY

Table of content: WANDA I SANTA CRESPO 1221P (NPI 1982819181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134257363 NPI number — BLAINE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLAINE COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BLAINE COUNTY AMBULANCE II
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134257363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 OHIO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINOOK
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-357-3240
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TURNER
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59542-0278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-357-3240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY CLERK
Authorized Official Telephone Number:
406-357-3240

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  129 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01622 . This is a "BCBS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0444886 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590059073 . This is a "RR MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: M000020033 . This is a "MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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