Provider Demographics
NPI:1952474413
Name:COUNTY OF WIBAUX
Entity Type:Organization
Organization Name:COUNTY OF WIBAUX
Other - Org Name:WIBAUX COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY COMMISSIONER
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MISKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-796-2481
Mailing Address - Street 1:PO BOX 199
Mailing Address - Street 2:
Mailing Address - City:WIBAUX
Mailing Address - State:MT
Mailing Address - Zip Code:59353-0199
Mailing Address - Country:US
Mailing Address - Phone:406-796-2481
Mailing Address - Fax:406-796-2625
Practice Address - Street 1:212 1ST AVE. SW
Practice Address - Street 2:
Practice Address - City:WIBAUX
Practice Address - State:MT
Practice Address - Zip Code:59353-0096
Practice Address - Country:US
Practice Address - Phone:406-796-2841
Practice Address - Fax:406-796-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4983416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT440128Medicaid
MTM000002293Medicare PIN