MEDICARE: MEMORIAL AMBULANCE OF FORT BENTON MONTANA

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	14	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	1352	OTHER	MT	BC/BS

General Provider Information

NPI Number	:	1932167640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL AMBULANCE OF FORT BENTON MONTANA

Provider Business Mailing Address
First Line	:	PO BOX 2458
Second Line	:
City	:	EUREKA
State	:	MT
Zip	:	59917-2458
Country	:	US
Telephone Number	:	406-297-1627
Fax Number	:	855-574-5392

Provider Business Practice Location Address
First Line	:	810 15TH ST
Second Line	:
City	:	FORT BENTON
State	:	MT
Zip	:	59442-8993
Country	:	US
Telephone Number	:	406-622-3400
Fax Number	:	406-622-4255

Authorized Official
Title or Position	:	SERVICE MANAGER
Name	:	AMBER L HURT
Credential	:	NREMTP
Telephone Number	:	406-301-4288

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	12/07/2021

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Directions to “MEMORIAL AMBULANCE OF FORT BENTON MONTANA ” Practice Location

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