MEDICARE: SUPERIOR VOLUNTEER FIRE COMPANY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	92	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000001372	OTHER	MT	BC/BS
4	155606200	OTHER	MT	OWCP
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235178906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR VOLUNTEER FIRE COMPANY INC

Provider Business Mailing Address
First Line	:	1940 S BONITO WAY STE 190
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-5618
Country	:	US
Telephone Number	:	208-287-9420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 5TH AVE E.
Second Line	:
City	:	SUPERIOR
State	:	MT
Zip	:	59872
Country	:	US
Telephone Number	:	406-822-3570
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	PATRICK ALAN METZGER
Credential	:
Telephone Number	:	406-822-3001

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	03/14/2023

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Directions to “SUPERIOR VOLUNTEER FIRE COMPANY INC ” Practice Location

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