Provider Demographics
NPI:1710080817
Name:COMMUNITY AMBULANCE SERVICE OF WESTERN SANDERS COUNTY, INC.
Entity Type:Organization
Organization Name:COMMUNITY AMBULANCE SERVICE OF WESTERN SANDERS COUNTY, INC.
Other - Org Name:NOXON AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:GERI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-847-2415
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:NOXON
Mailing Address - State:MT
Mailing Address - Zip Code:59853-0170
Mailing Address - Country:US
Mailing Address - Phone:406-847-2415
Mailing Address - Fax:406-847-3415
Practice Address - Street 1:311 NOXON AVE
Practice Address - Street 2:
Practice Address - City:NOXON
Practice Address - State:MT
Practice Address - Zip Code:59853-0170
Practice Address - Country:US
Practice Address - Phone:406-847-2415
Practice Address - Fax:403-847-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT061BLS3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0446615Medicaid
01722OtherBS
590007418OtherRRMCARE
MT1710080814Medicare UPIN
01722OtherBS
590007418OtherRRMCARE