Provider Demographics
NPI:1780629139
Name:COUNTY OF BIG HORN
Entity Type:Organization
Organization Name:COUNTY OF BIG HORN
Other - Org Name:BIG HORN COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BANION
Authorized Official - Suffix:
Authorized Official - Credentials:CCEMT-P
Authorized Official - Phone:406-665-8740
Mailing Address - Street 1:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-0908
Mailing Address - Country:US
Mailing Address - Phone:406-665-8740
Mailing Address - Fax:406-665-8751
Practice Address - Street 1:809 N CUSTER AVE
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-1311
Practice Address - Country:US
Practice Address - Phone:406-665-8740
Practice Address - Fax:406-665-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1093416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000449748Medicaid
MT001742OtherBC/BS
MT2129OtherCLEARING HOUSE
MT2129OtherCLEARING HOUSE
MTW56213Medicare UPIN