Provider Demographics
NPI:1619748084
Name:RAND W DICKSON INTERSTATE MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:RAND W DICKSON INTERSTATE MEDICAL TRANSPORT
Other - Org Name:INTERSTATE MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAND
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-740-2646
Mailing Address - Street 1:PO BOX 2458
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-2458
Mailing Address - Country:US
Mailing Address - Phone:406-297-1627
Mailing Address - Fax:
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-1440
Practice Address - Country:US
Practice Address - Phone:406-691-9304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport