Healthcare Provider Details

I. General information

NPI: 1306610035
Provider Name (Legal Business Name): RAND DICKSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 4TH ST
DEER LODGE MT
59722-1505
US

IV. Provider business mailing address

715 4TH ST
DEER LODGE MT
59722-1505
US

V. Phone/Fax

Practice location:
  • Phone: 406-740-2646
  • Fax:
Mailing address:
  • Phone: 406-740-2646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberMED-PARA-LIC-52339
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberMED-EMT-LIC-68132
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: