Healthcare Provider Details

I. General information

NPI: 1861450561
Provider Name (Legal Business Name): YELLOWSTONE CLUB PUBLIC SAFETY OF PRIVACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 YELLOWSTONE CLUB TRAIL
BIG SKY MT
59716
US

IV. Provider business mailing address

PO BOX 1359 1008 BURLINGTON AVE SUITE C
MISSOULA MT
59806-1359
US

V. Phone/Fax

Practice location:
  • Phone: 406-993-2973
  • Fax: 406-993-2974
Mailing address:
  • Phone: 406-549-7104
  • Fax: 406-542-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number173
License Number StateMT

VIII. Authorized Official

Name: JOHN R UNGARETTI
Title or Position: GENERAL MANAGER
Credential: CCEMPT
Phone: 406-549-7104