Provider Demographics
NPI:1073689915
Name:COUNTY OF FALLON
Entity Type:Organization
Organization Name:COUNTY OF FALLON
Other - Org Name:FALLON COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-778-5103
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:MT
Mailing Address - Zip Code:59313-0820
Mailing Address - Country:US
Mailing Address - Phone:406-778-5103
Mailing Address - Fax:406-778-5155
Practice Address - Street 1:9 WEST FALLON AVENUE
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:MT
Practice Address - Zip Code:59313-0638
Practice Address - Country:US
Practice Address - Phone:406-778-5104
Practice Address - Fax:406-778-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT001962OtherBLUE CROSS OF MT
MT448773Medicaid
MT011001335Medicare PIN