1467491134 NPI number — MISSOULA EMERGENCY SERVICES INC

Table of content: (NPI 1467491134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467491134 NPI number — MISSOULA EMERGENCY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSOULA EMERGENCY SERVICES 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:
6
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:
1467491134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2009
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:
1200 BURLINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-549-2325
Provider Business Practice Location Address Fax Number:
406-549-6495
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:  60 , 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: 9037698 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002243500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 224726 . This is a "BLUE SHIELD OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0442936 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1200275009037698 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9011140 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000065302 . This is a "BC/BS MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 206300 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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