Healthcare Provider Details

I. General information

NPI: 1750419123
Provider Name (Legal Business Name): BLAINE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 1ST AVE SW
HARLEM MT
59526
US

IV. Provider business mailing address

10 1ST AVE SW
HARLEM MT
59526
US

V. Phone/Fax

Practice location:
  • Phone: 406-357-3240
  • Fax:
Mailing address:
  • Phone: 406-357-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number128
License Number StateMT

VIII. Authorized Official

Name: TAMMY WILLIAMS
Title or Position: DEPUTY CLERK
Credential:
Phone: 406-357-3240