Provider Demographics
NPI:1790017226
Name:HARBOUR, KEITH A (EMT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:HARBOUR
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:29 MILE HIGH LN.
Mailing Address - City:ELLISTON
Mailing Address - State:MT
Mailing Address - Zip Code:59728-0196
Mailing Address - Country:US
Mailing Address - Phone:406-422-7185
Mailing Address - Fax:
Practice Address - Street 1:29 MILE HIGH LN.
Practice Address - Street 2:
Practice Address - City:ELLISTON
Practice Address - State:MT
Practice Address - Zip Code:59728-0196
Practice Address - Country:US
Practice Address - Phone:406-422-7185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT698146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic