Provider Demographics
NPI:1851676365
Name:AUTHENTIC AGENDA, INC.
Entity Type:Organization
Organization Name:AUTHENTIC AGENDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-600-2498
Mailing Address - Street 1:1011 BUCKRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:386 HAMMOND CREEK RD
Practice Address - Street 2:CRAZY MOUNTAIN RANCH
Practice Address - City:CLYDE PARK
Practice Address - State:MT
Practice Address - Zip Code:59018
Practice Address - Country:US
Practice Address - Phone:406-600-2498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty