1235176579 NPI number — NORTHEAST MONTANA STAT AIR AMUBLANCE COOPERATIVE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235176579 NPI number — NORTHEAST MONTANA STAT AIR AMUBLANCE COOPERATIVE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST MONTANA STAT AIR AMUBLANCE COOPERATIVE
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:
STAT AIR AMBULANCE
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:
1235176579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 AIRPORT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLASGOW
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59230-2842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-228-4687
Provider Business Mailing Address Fax Number:
406-228-4686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 AIRPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLASGOW
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59230-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-228-4687
Provider Business Practice Location Address Fax Number:
406-228-4686
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERGER
Authorized Official First Name:
CLAYTON
Authorized Official Middle Name:
Authorized Official Title or Position:
SERVICE DIRECTOR
Authorized Official Telephone Number:
406-228-4687

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  803 , 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)





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