1417981028 NPI number — COUNTY OF MUSSELSHELL

Table of content: (NPI 1417981028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417981028 NPI number — COUNTY OF MUSSELSHELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF MUSSELSHELL
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:
MUSSELSHELL COUNTY 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:
1417981028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
704 1ST ST E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROUNDUP
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59072-2302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-323-3554
Provider Business Mailing Address Fax Number:
406-323-2367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 1ST ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROUNDUP
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59072-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-323-3554
Provider Business Practice Location Address Fax Number:
406-323-2367
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOLBERG
Authorized Official First Name:
RON
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SERVICE DIRECTOR
Authorized Official Telephone Number:
406-323-3554

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  29 , 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: 119628600 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00154-2 . This is a "BCBS OF MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 447941 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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