Provider Demographics
NPI:1255493235
Name:TOWN OF ENNIS
Entity Type:Organization
Organization Name:TOWN OF ENNIS
Other - Org Name:ENNIS VOLUNTEER AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-682-4287
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-0147
Mailing Address - Country:US
Mailing Address - Phone:406-682-4287
Mailing Address - Fax:406-682-5011
Practice Address - Street 1:328 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729-0147
Practice Address - Country:US
Practice Address - Phone:406-682-4287
Practice Address - Fax:406-682-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT46146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT449553Medicaid
MT000002211Medicare ID - Type Unspecified