1073689915 NPI number — COUNTY OF FALLON

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 1073689915 NPI number — COUNTY OF FALLON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF FALLON
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:
FALLON COUNTY 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:
1073689915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 820
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKER
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59313-0820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-778-5103
Provider Business Mailing Address Fax Number:
406-778-5155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 WEST FALLON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKER
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59313-0638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-778-5104
Provider Business Practice Location Address Fax Number:
406-778-5155
Provider Enumeration Date:
11/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
SELENA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
406-778-5103

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001962 . This is a "BLUE CROSS OF MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 448773 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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