Healthcare Provider Details

I. General information

NPI: 1710793294
Provider Name (Legal Business Name): GRANITE PUBLIC SAFETY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E. BROADWAY STREET 194
PHILIPSBURG MT
59858-0181
US

IV. Provider business mailing address

35252 CRYSTAL CREEK CT
GRAFTON OH
44044-8807
US

V. Phone/Fax

Practice location:
  • Phone: 833-262-7877
  • Fax: 833-226-2235
Mailing address:
  • Phone: 833-262-7877
  • Fax: 833-226-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID EGING
Title or Position: DIRECTOR OF RISK MANAGEMENT AND COO
Credential:
Phone: 833-262-7877