1063451722 NPI number — AMBULANCE SERVICE INC

Table of content: (NPI 1063451722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063451722 NPI number — AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMBULANCE SERVICE INC
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:
1063451722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1008 BURLINGTON AVE STE C
Provider Second Line Business Mailing Address:
PO BOX 1359
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:
510 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEZ PERCE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-937-9909
Provider Business Practice Location Address Fax Number:
208-937-9787
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UNGARETTI
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
406-549-7104

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  7204 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000010015169 . This is a "REGENT BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 9054727 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: E1003 . This is a "BCBS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com