Provider Demographics
NPI:1437511821
Name:JESSE AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:JESSE AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:JESSE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:605-939-5668
Mailing Address - Street 1:201 E. HOLT
Mailing Address - Street 2:PO BOX 41
Mailing Address - City:BROADUS
Mailing Address - State:MT
Mailing Address - Zip Code:59317
Mailing Address - Country:US
Mailing Address - Phone:406-436-2225
Mailing Address - Fax:406-436-2033
Practice Address - Street 1:201 E. HOLT STREET
Practice Address - Street 2:
Practice Address - City:BROADUS
Practice Address - State:MT
Practice Address - Zip Code:59317-0041
Practice Address - Country:US
Practice Address - Phone:406-436-2225
Practice Address - Fax:406-436-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4463416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport