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General NPI Number Information
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NPI Number | 1700825478
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Entity Type | Organization
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Legal Business Name | POWELL COUNTY AMBULANCE SERVICE INC
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 05/24/2013
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Provider Practice Location Address
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Address Line | 1101 TEXAS AVE
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City | DEER LODGE
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State | MT
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Zip | 59722
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Country | US
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Telephone | 406-846-2212
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Fax | 406-846-6039
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Provider Business Mailing Address
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Address Line | PO BOX 1359 1243 BURLINGTON AVE
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City | MISSOULA
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State | MT
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Zip | 59806-1359
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Country | US
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Telephone | 406-549-7104
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Fax | 406-542-2785
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | JOHN R UNGARETTI
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Credential | CCEMTP
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Telephone | 406-549-7104
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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 | 043
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License Number State | MT
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