Healthcare Provider Details

I. General information

NPI: 1316463136
Provider Name (Legal Business Name): WILDERNESS MEDICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2069 NORMAN WAY
HAMILTON MT
59840
US

IV. Provider business mailing address

P.O. BOX 722
HAMILTON MT
59840
US

V. Phone/Fax

Practice location:
  • Phone: 800-294-4214
  • Fax: 406-924-1798
Mailing address:
  • Phone: 800-294-4214
  • Fax: 406-924-1798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4018
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number187
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number750
License Number StateMT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JACK E. SPEARS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 800-294-4214