Healthcare Provider Details

I. General information

NPI: 1104495720
Provider Name (Legal Business Name): POWDER RIVER COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E HOLT ST
BROADUS MT
59317-9502
US

IV. Provider business mailing address

PO BOX 200
BROADUS MT
59317-0200
US

V. Phone/Fax

Practice location:
  • Phone: 406-436-2361
  • Fax: 406-436-2151
Mailing address:
  • Phone: 406-436-2361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: ADAM W JOHNSON
Title or Position: DIRECTOR OF EMS
Credential:
Phone: 406-436-2361