1972513638 NPI number — NORTHERN CHEYENNE TRIBE

Table of content: (NPI 1972513638)

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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