Provider Demographics
NPI:1235176579
Name:NORTHEAST MONTANA STAT AIR AMUBLANCE COOPERATIVE
Entity Type:Organization
Organization Name:NORTHEAST MONTANA STAT AIR AMUBLANCE COOPERATIVE
Other - Org Name:STAT AIR AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-228-4687
Mailing Address - Street 1:81 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-2842
Mailing Address - Country:US
Mailing Address - Phone:406-228-4687
Mailing Address - Fax:406-228-4686
Practice Address - Street 1:81 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2842
Practice Address - Country:US
Practice Address - Phone:406-228-4687
Practice Address - Fax:406-228-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8033416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport