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General NPI Number Information
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NPI Number | 1811064397
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Entity Type | Organization
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Legal Business Name | ANACONDA-DEER LODGE COUNTY
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 420 W COMMERCIAL AVE
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City | ANACONDA
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State | MT
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Zip | 59711-2172
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Country | US
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Telephone | 406-563-2164
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Fax |
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Provider Business Mailing Address
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Address Line | 800 MAIN ST
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City | ANACONDA
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State | MT
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Zip | 59711-2950
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Country | US
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Telephone | 406-563-4000
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Fax |
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Authorized Official
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Title or Position | AMBULANCE SUPERVISOR
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Name | RJ TOCHER
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Credential |
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Telephone | 406-563-2164
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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 | 001
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License Number State | MT
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