Provider Demographics
NPI:1417981028
Name:COUNTY OF MUSSELSHELL
Entity Type:Organization
Organization Name:COUNTY OF MUSSELSHELL
Other - Org Name:MUSSELSHELL COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-323-3554
Mailing Address - Street 1:704 1ST ST E
Mailing Address - Street 2:
Mailing Address - City:ROUNDUP
Mailing Address - State:MT
Mailing Address - Zip Code:59072-2302
Mailing Address - Country:US
Mailing Address - Phone:406-323-3554
Mailing Address - Fax:406-323-2367
Practice Address - Street 1:704 1ST ST E
Practice Address - Street 2:
Practice Address - City:ROUNDUP
Practice Address - State:MT
Practice Address - Zip Code:59072-2302
Practice Address - Country:US
Practice Address - Phone:406-323-3554
Practice Address - Fax:406-323-2367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MUSSELSHELL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT29341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY119628600Medicaid
MT00154-2OtherBCBS OF MT
MT447941Medicaid
WY119628600Medicaid