Provider Demographics
NPI:1134254873
Name:CITY OF GLENDIVE
Entity type:Organization
Organization Name:CITY OF GLENDIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-377-3318
Mailing Address - Street 1:300 S MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-1610
Mailing Address - Country:US
Mailing Address - Phone:406-377-3318
Mailing Address - Fax:406-377-6873
Practice Address - Street 1:300 S MERRILL AVE
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-1610
Practice Address - Country:US
Practice Address - Phone:406-377-3318
Practice Address - Fax:406-377-6873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT48341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0445575Medicaid
MT000001292OtherBCBS
MT0445575Medicaid