Provider Demographics
NPI:1346399532
Name:MONTANA TRUCKS
Entity Type:Organization
Organization Name:MONTANA TRUCKS
Other - Org Name:MONTANA MOBILITY PRODUCTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:BOTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-541-7447
Mailing Address - Street 1:2045 MULLAN RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1835
Mailing Address - Country:US
Mailing Address - Phone:406-541-7447
Mailing Address - Fax:406-541-7449
Practice Address - Street 1:2045 MULLAN RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1835
Practice Address - Country:US
Practice Address - Phone:406-541-7447
Practice Address - Fax:406-541-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4D11332BC3200X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0036140Medicaid