1164404026 NPI number — THREE FORKS AREA AMBULANCE SERVICE DISTRICT

Table of content: (NPI 1164404026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164404026 NPI number — THREE FORKS AREA AMBULANCE SERVICE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THREE FORKS AREA AMBULANCE SERVICE DISTRICT
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:
Provider Other Organization Name Type Code:
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:
1164404026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 911
Provider Second Line Business Mailing Address:
15 E. DATE ST.
Provider Business Mailing Address City Name:
THREE FORKS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59752-0911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-285-3819
Provider Business Mailing Address Fax Number:
406-285-3819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 EAST DATE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THREE FORKS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59752-0911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-285-3819
Provider Business Practice Location Address Fax Number:
406-285-3819
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FRANK
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN OF THE BOARD OF DIRECTORS
Authorized Official Telephone Number:
406-285-3671

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  140 , 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: 442273 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 810472614 597520000 . This is a "TRICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 590006915 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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