Provider Demographics
NPI:1215030598
Name:GRASS RANGE QUICK RESPONSE UNIT INC
Entity Type:Organization
Organization Name:GRASS RANGE QUICK RESPONSE UNIT INC
Other - Org Name:GRASS RANGE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-428-2362
Mailing Address - Street 1:PO BOX 842
Mailing Address - Street 2:
Mailing Address - City:GRASS RANGE
Mailing Address - State:MT
Mailing Address - Zip Code:59032-0842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:607 NO MAIN ST
Practice Address - Street 2:
Practice Address - City:GRASS RANGE
Practice Address - State:MT
Practice Address - Zip Code:59032-8081
Practice Address - Country:US
Practice Address - Phone:406-428-2362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0440258Medicaid
MT12-00457-8OtherWORKERS COMP-STATE OF MT
MT000002398-PARTBMedicare PIN