Provider Demographics
NPI:1497781843
Name:MONTANA MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:MONTANA MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAXNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-442-2190
Mailing Address - Street 1:2430 AIRPORT RD STE 2
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-1234
Mailing Address - Country:US
Mailing Address - Phone:406-442-2190
Mailing Address - Fax:406-442-2199
Practice Address - Street 1:2430 AIRPORT RD STE 2
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-1234
Practice Address - Country:US
Practice Address - Phone:406-442-2190
Practice Address - Fax:406-442-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT174341600000X
MT8073416A0800X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0442119Medicaid
MT000020036Medicare ID - Type Unspecified