Provider Demographics
NPI:1538289657
Name:COUNTY OF GOLDEN VALLEY OFFICE OF CLERK & RECORDER
Entity Type:Organization
Organization Name:COUNTY OF GOLDEN VALLEY OFFICE OF CLERK & RECORDER
Other - Org Name:GOLDEN VALLEY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-568-2321
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:RYEGATE
Mailing Address - State:MT
Mailing Address - Zip Code:59074-0055
Mailing Address - Country:US
Mailing Address - Phone:406-568-2321
Mailing Address - Fax:406-568-2598
Practice Address - Street 1:107 KEMP STREET
Practice Address - Street 2:
Practice Address - City:RYEGATE
Practice Address - State:MT
Practice Address - Zip Code:59074
Practice Address - Country:US
Practice Address - Phone:406-568-2321
Practice Address - Fax:406-568-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000020012OtherBLUE CROSS
MT590014533OtherRR MEDICARE
MT272833Medicaid
MT272833Medicaid