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General NPI Number Information
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NPI Number | 1316204829
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Entity Type | Organization
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Legal Business Name | WHITEWATER RESCUE INSTITUTE, INC.
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 111 N HIGGINS AVE
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City | MISSOULA
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State | MT
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Zip | 59802-4437
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Country | US
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Telephone | 406-207-2027
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8598
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City | MISSOULA
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State | MT
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Zip | 59807-8598
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Country | US
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Telephone | 406-207-2027
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Fax | 406-258-0704
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CODY DANE HARRIS
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Credential |
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Telephone | 406-207-2027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State | MT
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