Healthcare Provider Details

I. General information

NPI: 1770943771
Provider Name (Legal Business Name): WISE RIVER VOLUNTEER FIRE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64795 MT HIGHWAY 43
WISE RIVER MT
59762-9700
US

IV. Provider business mailing address

PO BOX 143
WISE RIVER MT
59762-0143
US

V. Phone/Fax

Practice location:
  • Phone: 406-832-3366
  • Fax:
Mailing address:
  • Phone: 406-832-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: YVONNE JONES
Title or Position: SECRETARY-TREASURER
Credential: WISE RIVER VOLUNTEER
Phone: 406-832-3130