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General NPI Number Information
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NPI Number | 1437511821
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Entity Type | Organization
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Legal Business Name | JESSE AMBULANCE SERVICE LLC
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 201 E. HOLT STREET
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City | BROADUS
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State | MT
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Zip | 59317-0041
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Country | US
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Telephone | 406-436-2225
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Fax | 406-436-2033
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Provider Business Mailing Address
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Address Line | 201 E. HOLT PO BOX 41
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City | BROADUS
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State | MT
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Zip | 59317
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Country | US
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Telephone | 406-436-2225
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Fax | 406-436-2033
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Authorized Official
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Title or Position | ORGANIZER
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Name | MR. RICHARD G. JESSE
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Credential | EMT
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Telephone | 605-939-5668
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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 | 446
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License Number State | MT
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