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General NPI Number Information
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NPI Number | 1518219617
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Entity Type | Organization
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Legal Business Name | PURE MEDICAL INC
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 5515 BONANZA PLACE
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City | MISSOULA
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State | MT
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Zip | 59808
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Country | US
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Telephone | 406-721-3647
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Fax |
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Provider Business Mailing Address
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Address Line | 5515 BONANZA PLACE
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City | MISSOULA
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State | MT
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Zip | 59808
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Country | US
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Telephone | 406-721-3647
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Fax |
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Authorized Official
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Title or Position | MANAGER/CEO
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Name | MR. KURT R SCHALLOCK
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Credential |
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Telephone | 406-721-3647
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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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