Provider Demographics
NPI:1720389166
Name:GRASSHOPPER VALLEY VOLUNTEER FIRE COMPANY
Entity Type:Organization
Organization Name:GRASSHOPPER VALLEY VOLUNTEER FIRE COMPANY
Other - Org Name:GRASSHOPPER VALLEY VOLUNTEER FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-834-3497
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:406-834-3412
Mailing Address - Fax:
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:406-834-3412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2014-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT207PE0004X341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011001107OtherMEDICARE PTAN
MT000020027Medicare PIN