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General NPI Number Information
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NPI Number | 1164190567
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Entity Type | Organization
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Legal Business Name | VITALOGY EMS LLC
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 468 ASH RD
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City | KALISPELL
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State | MT
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Zip | 59901-2325
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Country | US
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Telephone | 406-270-6955
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Fax | 406-309-2127
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Provider Business Mailing Address
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Address Line | 724 SHADOW LN
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City | KALISPELL
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State | MT
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Zip | 59901-2340
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Country | US
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Telephone | 406-270-6955
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Fax | 406-309-2127
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRODIE VERWORN
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Credential |
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Telephone | 406-546-1232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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