Healthcare Provider Details

I. General information

NPI: 1467491134
Provider Name (Legal Business Name): MISSOULA EMERGENCY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BURLINGTON AVE
MISSOULA MT
59801
US

IV. Provider business mailing address

PO BOX 1359
MISSOULA MT
59806-1359
US

V. Phone/Fax

Practice location:
  • Phone: 406-549-2325
  • Fax: 406-549-6495
Mailing address:
  • Phone: 406-549-7104
  • Fax: 406-542-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number60
License Number StateMT

VIII. Authorized Official

Name: JOHN R UNGARETTI
Title or Position: GENERAL MANAGER
Credential: CCEMTP
Phone: 406-549-7104