Provider Demographics
NPI:1629171723
Name:TROY VOLUNTEER AMBULANCE
Entity Type:Organization
Organization Name:TROY VOLUNTEER AMBULANCE
Other - Org Name:TROY AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-295-6505
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MT
Mailing Address - Zip Code:59935-0641
Mailing Address - Country:US
Mailing Address - Phone:406-295-6505
Mailing Address - Fax:406-295-6510
Practice Address - Street 1:210 N THIRD ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MT
Practice Address - Zip Code:59935-0641
Practice Address - Country:US
Practice Address - Phone:406-295-6505
Practice Address - Fax:406-295-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT066A1S3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0446173Medicaid
001992OtherBS
590015285OtherRRMCARE
MT0446173Medicaid