Healthcare Provider Details

I. General information

NPI: 1003099318
Provider Name (Legal Business Name): GRASSHOPPER VALLEY VOLUNTEER FIRE DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9753 PIONEER MOUNTAINS SCENIC BYWAY
POLARIS MT
59746-0484
US

IV. Provider business mailing address

PO BOX 460484
POLARIS MT
59746-0484
US

V. Phone/Fax

Practice location:
  • Phone: 406-834-3541
  • Fax: 406-834-3497
Mailing address:
  • Phone: 406-834-3541
  • Fax: 406-834-3497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number167
License Number StateMT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. ARCHIE H MATTHEWS
Title or Position: CAPTAIN
Credential: EMTB
Phone: 406-834-3541