Healthcare Provider Details

I. General information

NPI: 1528007291
Provider Name (Legal Business Name): SEELEY LAKE FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FIRE HOUSE LANE
SEELEY LAKE MT
59868
US

IV. Provider business mailing address

PO BOX 1359 1243 BURLINGTON AVE
MISSOULA MT
59806-1359
US

V. Phone/Fax

Practice location:
  • Phone: 406-677-2400
  • Fax:
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 Number64
License Number StateMT

VIII. Authorized Official

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