Healthcare Provider Details

I. General information

NPI: 1154396067
Provider Name (Legal Business Name): COUNTY OF ROSEBUD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 WILLOW AVE
COLSTRIP MT
59323-0998
US

IV. Provider business mailing address

PO BOX 998
COLSTRIP MT
59323-0998
US

V. Phone/Fax

Practice location:
  • Phone: 406-748-3136
  • Fax:
Mailing address:
  • Phone: 406-748-3136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number130
License Number StateMT

VIII. Authorized Official

Name: MR. SHAWN HAGE
Title or Position: DIRECTOR
Credential:
Phone: 406-748-3136