MEDICARE: MARION VOLUNTEER FIRE DEPARTMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	505	MT

General Provider Information

NPI Number	:	1285887364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARION VOLUNTEER FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	1008 BURLINGTON AVE STE C
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-5682
Country	:	US
Telephone Number	:	406-549-7104
Fax Number	:	406-542-2785

Provider Business Practice Location Address
First Line	:	180 GOPHER LANE
Second Line	:
City	:	MARION
State	:	MT
Zip	:	59925-0000
Country	:	US
Telephone Number	:	406-854-2828
Fax Number	:	406-854-9330

Authorized Official
Title or Position	:	DIRECTOR/OFFICER
Name	:	MR. LARRY BROWER
Credential	:
Telephone Number	:	406-854-2828

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	11/05/2008

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