Healthcare Provider Details

I. General information

NPI: 1376696500
Provider Name (Legal Business Name): CITY OF BOULDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W SECOND AVE AMBULANCE BARN
BOULDER MT
59632-0068
US

IV. Provider business mailing address

PO BOX 68
BOULDER MT
59632-0068
US

V. Phone/Fax

Practice location:
  • Phone: 406-225-3381
  • Fax: 406-225-9498
Mailing address:
  • Phone: 406-225-3381
  • Fax: 406-225-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number005
License Number StateMT

VIII. Authorized Official

Name: MR. DARYL CRAFT
Title or Position: MAYOR CITY OF BOULDER
Credential:
Phone: 406-228-3381