=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417981028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF MUSSELSHELL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2006
-----------------------------------------------------
Last Update Date | 10/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 704 1ST ST E
-----------------------------------------------------
City | ROUNDUP
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59072-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-323-3554
-----------------------------------------------------
Fax | 406-323-2367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 704 1ST ST E
-----------------------------------------------------
City | ROUNDUP
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59072-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-323-3554
-----------------------------------------------------
Fax | 406-323-2367
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SERVICE DIRECTOR
-----------------------------------------------------
Name | MR. RON J SOLBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-323-3554
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 29
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------