Provider Demographics
NPI:1770635336
Name:COUNTY OF JUDITH BASIN
Entity Type:Organization
Organization Name:COUNTY OF JUDITH BASIN
Other - Org Name:COUNTY OF JUDITH BASIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:AUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-566-2277
Mailing Address - Street 1:91 3RD STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:MT
Mailing Address - Zip Code:59479-0427
Mailing Address - Country:US
Mailing Address - Phone:406-566-2277
Mailing Address - Fax:
Practice Address - Street 1:91 3RD STREET NORTH
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:MT
Practice Address - Zip Code:59479-0427
Practice Address - Country:US
Practice Address - Phone:406-566-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF JUDITH BASIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-16
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT440024Medicaid
MT65182OtherBCBS
MT440024Medicaid
MT=========OtherTAX ID