Healthcare Provider Details

I. General information

NPI: 1700825478
Provider Name (Legal Business Name): POWELL COUNTY AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 TEXAS AVE
DEER LODGE MT
59722
US

IV. Provider business mailing address

PO BOX 1359 1243 BURLINGTON AVE
MISSOULA MT
59806-1359
US

V. Phone/Fax

Practice location:
  • Phone: 406-846-2212
  • Fax: 406-846-6039
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 Number043
License Number StateMT

VIII. Authorized Official

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