Provider Demographics
NPI:1780752295
Name:AUGUSTA VOLUNTEER AMBULANCE
Entity type:Organization
Organization Name:AUGUSTA VOLUNTEER AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:R
Authorized Official - Last Name:GEISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-562-3697
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:MT
Mailing Address - Zip Code:59410-0408
Mailing Address - Country:US
Mailing Address - Phone:406-562-3277
Mailing Address - Fax:
Practice Address - Street 1:410 MANIX STREET
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:MT
Practice Address - Zip Code:59410-0408
Practice Address - Country:US
Practice Address - Phone:406-562-3697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0446498Medicaid
MT0000001422OtherBLUE CROSS BLUE SHIELD MT