Healthcare Provider Details

I. General information

NPI: 1174661649
Provider Name (Legal Business Name): MEDICAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 PARK ST
MISSOULA MT
59801-8762
US

IV. Provider business mailing address

PO BOX 1597
MISSOULA MT
59806-1597
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-1510
  • Fax: 406-829-0482
Mailing address:
  • Phone: 406-327-1510
  • Fax: 406-829-0482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number9199
License Number StateMT

VIII. Authorized Official

Name: MS. PEGGY L METIVIER
Title or Position: MANAGER
Credential:
Phone: 406-327-1510