MEDICARE: COUNTY OF MUSSELSHELL

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	341600000X	Ambulance	29	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00154-2	OTHER	MT	BCBS OF MT
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417981028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF MUSSELSHELL

Provider Business Mailing Address
First Line	:	704 1ST ST E
Second Line	:
City	:	ROUNDUP
State	:	MT
Zip	:	59072-2302
Country	:	US
Telephone Number	:	406-323-3554
Fax Number	:	406-323-2367

Provider Business Practice Location Address
First Line	:	704 1ST ST E
Second Line	:
City	:	ROUNDUP
State	:	MT
Zip	:	59072-2302
Country	:	US
Telephone Number	:	406-323-3554
Fax Number	:	406-323-2367

Authorized Official
Title or Position	:	SERVICE DIRECTOR
Name	:	MR. RON J SOLBERG
Credential	:
Telephone Number	:	406-323-3554

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	10/25/2012

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Directions to “COUNTY OF MUSSELSHELL ” Practice Location

Language	Start Address	Practice Location

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