=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609921311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WORDEN FIRE DEPARTMENT, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2463 3RD STREET
-----------------------------------------------------
City | WORDEN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-967-2114
-----------------------------------------------------
Fax | 406-967-2110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 369
-----------------------------------------------------
City | WORDEN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-967-2114
-----------------------------------------------------
Fax | 406-967-2110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY OF THE BOARD
-----------------------------------------------------
Name | MS. EILEEN JEANETTE JENSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-967-3561
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 095
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------