Provider Demographics
NPI:1184862401
Name:GERALDINE COMMUNITY AMBULANCE
Entity Type:Organization
Organization Name:GERALDINE COMMUNITY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:ENGELLANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-622-3600
Mailing Address - Street 1:P.O. BX 755
Mailing Address - Street 2:
Mailing Address - City:FORT BENTON
Mailing Address - State:MT
Mailing Address - Zip Code:59442-0755
Mailing Address - Country:US
Mailing Address - Phone:406-622-3600
Mailing Address - Fax:406-622-3600
Practice Address - Street 1:2235 N SHINE LAKE RD.
Practice Address - Street 2:
Practice Address - City:GERALDINE
Practice Address - State:MT
Practice Address - Zip Code:59446-0123
Practice Address - Country:US
Practice Address - Phone:406-622-3600
Practice Address - Fax:406-622-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport