Provider Demographics
NPI:1689613341
Name:JOLIET EMERGENCY MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:JOLIET EMERGENCY MEDICAL SERVICES INC
Other - Org Name:JOLIET EMERGENCY MEDICAL SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-962-3472
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:MT
Mailing Address - Zip Code:59041-0324
Mailing Address - Country:US
Mailing Address - Phone:406-962-3472
Mailing Address - Fax:406-962-3472
Practice Address - Street 1:522 EAST FRONT AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:MT
Practice Address - Zip Code:59041
Practice Address - Country:US
Practice Address - Phone:406-962-3472
Practice Address - Fax:406-962-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT553416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT103920900OtherOWCP WORK COMP
MT0440725Medicaid
MTM000002396Medicare PIN
MT0440725Medicaid