MEDICARE: PARK CITY AMBULANCE SERVICE

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	105	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	65102	OTHER	MT	BCBS

General Provider Information

NPI Number	:	1730147430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK CITY AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 292
Second Line	:
City	:	PARK CITY
State	:	MT
Zip	:	59063
Country	:	US
Telephone Number	:	406-549-7104
Fax Number	:	406-542-2785

Provider Business Practice Location Address
First Line	:	102 1ST AVE SW
Second Line	:
City	:	PARK CITY
State	:	MT
Zip	:	59063
Country	:	US
Telephone Number	:	406-633-2345
Fax Number	:	406-633-2015

Authorized Official
Title or Position	:	BOARD DIRECTOR
Name	:	MR. MYRON GROSS
Credential	:
Telephone Number	:	406-633-9898

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	10/24/2018

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Directions to “PARK CITY AMBULANCE SERVICE ” Practice Location

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