Provider Demographics
NPI:1104136365
Name:LITTLE SNAKE RIVER EMERGENCY MEDICAL SERVICES
Entity type:Organization
Organization Name:LITTLE SNAKE RIVER EMERGENCY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEROLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-383-7000
Mailing Address - Street 1:305 WHIPPOORWILL DRIVE
Mailing Address - Street 2:P O B 307
Mailing Address - City:BAGGS
Mailing Address - State:WY
Mailing Address - Zip Code:82321-0307
Mailing Address - Country:US
Mailing Address - Phone:307-383-7000
Mailing Address - Fax:307-383-7005
Practice Address - Street 1:305 WHIPPOORWILL DRIVE
Practice Address - Street 2:PO B 307
Practice Address - City:BAGGS
Practice Address - State:WY
Practice Address - Zip Code:82321-0307
Practice Address - Country:US
Practice Address - Phone:307-383-7000
Practice Address - Fax:307-383-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance