Provider Demographics
NPI:1811045511
Name:COUNTY OF PRAIRIE
Entity Type:Organization
Organization Name:COUNTY OF PRAIRIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMERGENCY SERVICES COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:PISK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-635-5738
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:217 WEST PARK ST
Mailing Address - City:TERRY
Mailing Address - State:MT
Mailing Address - Zip Code:59349-0126
Mailing Address - Country:US
Mailing Address - Phone:406-635-5738
Mailing Address - Fax:406-635-4126
Practice Address - Street 1:217 WEST PARK ST
Practice Address - Street 2:
Practice Address - City:TERRY
Practice Address - State:MT
Practice Address - Zip Code:59349-0126
Practice Address - Country:US
Practice Address - Phone:406-635-5738
Practice Address - Fax:406-635-4126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRAIRIE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT074146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM000002209Medicare PIN