Provider Demographics
NPI:1376583914
Name:BIG SANDY VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:BIG SANDY VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:JERREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-868-9932
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:BIG SANDY
Mailing Address - State:MT
Mailing Address - Zip Code:59520-0157
Mailing Address - Country:US
Mailing Address - Phone:406-378-2188
Mailing Address - Fax:406-378-2180
Practice Address - Street 1:258 JUDITH LANDING ROAD
Practice Address - Street 2:
Practice Address - City:BIG SANDY
Practice Address - State:MT
Practice Address - Zip Code:59520-0157
Practice Address - Country:US
Practice Address - Phone:406-378-2188
Practice Address - Fax:406-378-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT065482OtherBLUE CROSS/BLUE SHIELD
MT0000065482OtherBLUE CROSS/SHIELD
MT1376583914Medicaid
MT065482OtherBLUE CROSS/BLUE SHIELD
MT0000065482OtherBLUE CROSS/SHIELD