Healthcare Provider Details

I. General information

NPI: 1104716307
Provider Name (Legal Business Name): BIG SKY AMBULANCE RB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 4TH AVE N
GREAT FALLS MT
59401-2731
US

IV. Provider business mailing address

1911 4TH AVE N
GREAT FALLS MT
59401-2731
US

V. Phone/Fax

Practice location:
  • Phone: 406-399-1464
  • Fax:
Mailing address:
  • Phone: 406-399-1464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK BENJAMIN
Title or Position: PRESIDENT
Credential: MD
Phone: 406-399-1464