Provider Demographics
NPI:1467491134
Name:MISSOULA EMERGENCY SERVICES INC
Entity Type:Organization
Organization Name:MISSOULA EMERGENCY SERVICES INC
Other - Org Name:MISSOULA EMERGENCY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:UNGARETTI
Authorized Official - Suffix:
Authorized Official - Credentials:CCEMTP
Authorized Official - Phone:406-549-7104
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-1359
Mailing Address - Country:US
Mailing Address - Phone:406-549-7104
Mailing Address - Fax:406-542-2785
Practice Address - Street 1:1200 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-549-2325
Practice Address - Fax:406-549-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9037698Medicaid
ID002243500Medicaid
PA224726OtherBLUE SHIELD OF PA
MT0442936Medicaid
WY1200275009037698Medicaid
SD9011140Medicaid
MT0000065302OtherBC/BS MT
OR206300Medicaid
WA9037698Medicaid
OR206300Medicaid
ID002243500Medicaid