Healthcare Provider Details

I. General information

NPI: 1780630616
Provider Name (Legal Business Name): MISSION VALLEY AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 FIRST AVE
ST IGNATIUS MT
59865
US

IV. Provider business mailing address

PO BOX 1359
MISSOULA MT
59806-1359
US

V. Phone/Fax

Practice location:
  • Phone: 406-745-4190
  • Fax: 406-745-2757
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 Number88
License Number StateMT

VIII. Authorized Official

Name: MS. CHRISTA UMPHREY
Title or Position: DIRECTOR
Credential: EMT
Phone: 406-745-4190