Provider Demographics
NPI:1063451722
Name:AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:UNGARETTI
Authorized Official - Suffix:
Authorized Official - Credentials:CCEMTP
Authorized Official - Phone:406-549-7104
Mailing Address - Street 1:1008 BURLINGTON AVE STE C
Mailing Address - Street 2:PO BOX 1359
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-1359
Mailing Address - Country:US
Mailing Address - Phone:406-549-7104
Mailing Address - Fax:406-542-2785
Practice Address - Street 1:510 OAK ST
Practice Address - Street 2:
Practice Address - City:NEZ PERCE
Practice Address - State:ID
Practice Address - Zip Code:83543
Practice Address - Country:US
Practice Address - Phone:208-937-9909
Practice Address - Fax:208-937-9787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID72043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010015169OtherREGENT BLUE SHIELD
WA9054727Medicaid
IDE1003OtherBCBS
WA9054727Medicaid
=========Medicare UPIN
ID1503094Medicare ID - Type UnspecifiedRAILROAD MEDICARE