1780630616 NPI number — MISSION VALLEY AMBULANCE

Table of content: MARTHA LEA ARREDONDO (NPI 1972709723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780630616 NPI number — MISSION VALLEY AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSION VALLEY AMBULANCE
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:
MISSION VALLEY 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:
1780630616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1359
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59806-1359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-549-7104
Provider Business Mailing Address Fax Number:
406-542-2785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 FIRST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST IGNATIUS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-745-4190
Provider Business Practice Location Address Fax Number:
406-745-2757
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UMPHREY
Authorized Official First Name:
CHRISTA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
406-745-4190

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  88 , 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: 329880700 . This is a "OWCP WORKERS COMP" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0442013 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65012 . This is a "BCBS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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