MEDICARE: EAGLE AMBULANCE SERVICE,INC

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	079	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

General Provider Information

NPI Number	:	1770523128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE AMBULANCE SERVICE,INC

Provider Business Mailing Address
First Line	:	PO BOX 822
Second Line	:
City	:	EAST HELENA
State	:	MT
Zip	:	59635-0822
Country	:	US
Telephone Number	:	406-441-9111
Fax Number	:	406-449-6302

Provider Business Practice Location Address
First Line	:	6 MARKET ST
Second Line	:
City	:	CLANCY
State	:	MT
Zip	:	59634-9767
Country	:	US
Telephone Number	:	406-441-9111
Fax Number	:	406-449-6302

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KATHERINE R JACKSON
Credential	:
Telephone Number	:	406-441-9111

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	10/07/2009

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