Provider Demographics
NPI:1073706321
Name:REDWATER VALLEY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:REDWATER VALLEY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-460-0007
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:CIRCLE
Mailing Address - State:MT
Mailing Address - Zip Code:59215-0567
Mailing Address - Country:US
Mailing Address - Phone:406-485-2313
Mailing Address - Fax:
Practice Address - Street 1:606 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:CIRCLE
Practice Address - State:MT
Practice Address - Zip Code:59215-0567
Practice Address - Country:US
Practice Address - Phone:406-485-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3416L0300X3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0295113Medicaid
MT0295113Medicaid