1972513638 NPI number — NORTHERN CHEYENNE TRIBE

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 1972513638 NPI number — NORTHERN CHEYENNE TRIBE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN CHEYENNE TRIBE
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:
NORTHERN CHEYENNE AMBULANCE SERVICE
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:
1972513638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 NORTH CHEYENNE AVE
Provider Second Line Business Mailing Address:
PO BOX 67
Provider Business Mailing Address City Name:
LAME DEER
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59043-0067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-477-6775
Provider Business Mailing Address Fax Number:
406-477-6083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 NORTH CHEYENNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAME DEER
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59043-0067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-477-6775
Provider Business Practice Location Address Fax Number:
406-477-6083
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LARANCE
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
3RD PARTY BILLING CLERK
Authorized Official Telephone Number:
406-477-4911

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  087 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 087 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0191-2 . This is a "BLUECROSS BLUESHIELD OF MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0445263 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011002659 . This is a "MEDICARE PTAN - NORIDIAN" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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