Healthcare Provider Details

I. General information

NPI: 1275874919
Provider Name (Legal Business Name): MEDEVENT911 MONTANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 MCDONALD AVE
MISSOULA MT
59801-8402
US

IV. Provider business mailing address

1930 MCDONALD AVE
MISSOULA MT
59801-8402
US

V. Phone/Fax

Practice location:
  • Phone: 877-811-6760
  • Fax: 480-247-5512
Mailing address:
  • Phone: 877-811-6760
  • Fax: 480-247-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number State

VIII. Authorized Official

Name: TERESSA A MCCLUSKEY
Title or Position: PRESIDENT
Credential:
Phone: 877-811-6760