Provider Demographics
NPI:1366506370
Name:COUNTY OF BLAINE MONTANA
Entity Type:Organization
Organization Name:COUNTY OF BLAINE MONTANA
Other - Org Name:BLAINE COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLERK & RECORDER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-357-3240
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:CHINOOK
Mailing Address - State:MT
Mailing Address - Zip Code:59523-0278
Mailing Address - Country:US
Mailing Address - Phone:406-357-3240
Mailing Address - Fax:406-357-2199
Practice Address - Street 1:420 OHIO ST
Practice Address - Street 2:
Practice Address - City:CHINOOK
Practice Address - State:MT
Practice Address - Zip Code:59523-0278
Practice Address - Country:US
Practice Address - Phone:406-357-3240
Practice Address - Fax:460-357-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT01622OtherBLUE CROSS BLUE SHIELD
MT590059073OtherRAIL ROAD MEDICARE
MT0444886Medicaid
MTM000002274OtherMEDICARE
MT0444886Medicaid