Provider Demographics
NPI:1326152398
Name:COUNTY OF PETROLEUM
Entity Type:Organization
Organization Name:COUNTY OF PETROLEUM
Other - Org Name:PETROLEUM COUNTY AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BEVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-429-5551
Mailing Address - Street 1:P.O. BOX 226
Mailing Address - Street 2:
Mailing Address - City:WINNETT
Mailing Address - State:MT
Mailing Address - Zip Code:59087-0226
Mailing Address - Country:US
Mailing Address - Phone:406-429-5551
Mailing Address - Fax:406-429-6328
Practice Address - Street 1:16 S BRODWAY
Practice Address - Street 2:
Practice Address - City:WINNETT
Practice Address - State:MT
Practice Address - Zip Code:59087-0226
Practice Address - Country:US
Practice Address - Phone:406-429-5551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT069341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT041099Medicaid
MT0000065382OtherBLUE CROSS BLUE SHIELD