Healthcare Provider Details

I. General information

NPI: 1932167640
Provider Name (Legal Business Name): MEMORIAL AMBULANCE OF FORT BENTON MONTANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 15TH ST
FORT BENTON MT
59442-8993
US

IV. Provider business mailing address

PO BOX 2458
EUREKA MT
59917-2458
US

V. Phone/Fax

Practice location:
  • Phone: 406-622-3400
  • Fax: 406-622-4255
Mailing address:
  • Phone: 406-297-1627
  • Fax: 855-574-5392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number14
License Number StateMT

VIII. Authorized Official

Name: AMBER L HURT
Title or Position: SERVICE MANAGER
Credential: NREMTP
Phone: 406-301-4288