Provider Demographics
NPI:1225096944
Name:GRANITE COUNTY
Entity Type:Organization
Organization Name:GRANITE COUNTY
Other - Org Name:DRUMMOND VOLUNTEER AMBULANCE ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DRUMMOND AMBULANCE ASSOC
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:406-288-3191
Mailing Address - Street 1:202 EAST FRONT STREET, P.O. BOX 389
Mailing Address - Street 2:
Mailing Address - City:DRUMMOND
Mailing Address - State:MT
Mailing Address - Zip Code:59832
Mailing Address - Country:US
Mailing Address - Phone:406-288-3191
Mailing Address - Fax:406-542-2785
Practice Address - Street 1:202 EAST FRONT STREET
Practice Address - Street 2:
Practice Address - City:DRUMMOND
Practice Address - State:MT
Practice Address - Zip Code:59832
Practice Address - Country:US
Practice Address - Phone:406-288-3191
Practice Address - Fax:406-542-2785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRANITE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-02
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0843416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0449449Medicaid
MT6528OtherBC BS
WA9055864Medicaid
MTM000002329Medicare PIN