Provider Demographics
NPI:1003099318
Name:GRASSHOPPER VALLEY VOLUNTEER FIRE DEPT
Entity type:Organization
Organization Name:GRASSHOPPER VALLEY VOLUNTEER FIRE DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:ARCHIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:EMTB
Authorized Official - Phone:406-834-3541
Mailing Address - Street 1:PO BOX 460484
Mailing Address - Street 2:
Mailing Address - City:POLARIS
Mailing Address - State:MT
Mailing Address - Zip Code:59746-0484
Mailing Address - Country:US
Mailing Address - Phone:406-834-3541
Mailing Address - Fax:406-834-3497
Practice Address - Street 1:9753 PIONEER MOUNTAINS SCENIC BYWAY
Practice Address - Street 2:
Practice Address - City:POLARIS
Practice Address - State:MT
Practice Address - Zip Code:59746-0484
Practice Address - Country:US
Practice Address - Phone:406-834-3541
Practice Address - Fax:406-834-3497
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRASSHOPPER VALLEY VOLUNTEER FIRE DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT167207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty