Provider Demographics
NPI:1558418327
Name:TOWN OF BRIDGER
Entity Type:Organization
Organization Name:TOWN OF BRIDGER
Other - Org Name:CLARKS FORK VALLEY AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEFFAN
Authorized Official - Suffix:
Authorized Official - Credentials:EMTB
Authorized Official - Phone:406-662-9930
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:BRIDGER
Mailing Address - State:MT
Mailing Address - Zip Code:59014-0094
Mailing Address - Country:US
Mailing Address - Phone:406-662-9930
Mailing Address - Fax:406-662-9930
Practice Address - Street 1:210 SOUTH C STREET
Practice Address - Street 2:
Practice Address - City:BRIDGER
Practice Address - State:MT
Practice Address - Zip Code:59014-0094
Practice Address - Country:US
Practice Address - Phone:406-662-9930
Practice Address - Fax:406-662-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0393416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0440419Medicaid
MT000002265Medicare ID - Type Unspecified