=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235178906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPERIOR VOLUNTEER FIRE COMPANY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2006
-----------------------------------------------------
Last Update Date | 03/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1202 5TH AVE E.
-----------------------------------------------------
City | SUPERIOR
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-822-3570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1940 S BONITO WAY STE 190
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83642-5618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-287-9420
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN
-----------------------------------------------------
Name | PATRICK ALAN METZGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-822-3001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 92
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------