Provider Demographics
NPI:1164404026
Name:THREE FORKS AREA AMBULANCE SERVICE DISTRICT
Entity Type:Organization
Organization Name:THREE FORKS AREA AMBULANCE SERVICE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-285-3671
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:15 E. DATE ST.
Mailing Address - City:THREE FORKS
Mailing Address - State:MT
Mailing Address - Zip Code:59752-0911
Mailing Address - Country:US
Mailing Address - Phone:406-285-3819
Mailing Address - Fax:406-285-3819
Practice Address - Street 1:15 EAST DATE STREET
Practice Address - Street 2:
Practice Address - City:THREE FORKS
Practice Address - State:MT
Practice Address - Zip Code:59752-0911
Practice Address - Country:US
Practice Address - Phone:406-285-3819
Practice Address - Fax:406-285-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT140341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT442273Medicaid
MT810472614 597520000OtherTRICARE
MT590006915OtherRAILROAD MEDICARE
MT810472614 597520000OtherTRICARE