Provider Demographics
NPI:1528007291
Name:SEELEY LAKE FIRE DISTRICT
Entity Type:Organization
Organization Name:SEELEY LAKE FIRE DISTRICT
Other - Org Name:
Other - Org Type:
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 2:1243 BURLINGTON AVE
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 1:200 FIRE HOUSE LANE
Practice Address - Street 2:
Practice Address - City:SEELEY LAKE
Practice Address - State:MT
Practice Address - Zip Code:59868
Practice Address - Country:US
Practice Address - Phone:406-677-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT643416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0441467Medicaid
MT1522OtherBCBS
AKGA909MTMedicaid
MT0441467Medicaid
MTM000002278Medicare PIN