Provider Demographics
NPI:1811064397
Name:ANACONDA-DEER LODGE COUNTY
Entity type:Organization
Organization Name:ANACONDA-DEER LODGE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RJ
Authorized Official - Middle Name:
Authorized Official - Last Name:TOCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-563-2164
Mailing Address - Street 1:800 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2950
Mailing Address - Country:US
Mailing Address - Phone:406-563-4000
Mailing Address - Fax:
Practice Address - Street 1:420 W COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2172
Practice Address - Country:US
Practice Address - Phone:406-563-2164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT590059327OtherRAILROAD MEDICARE
MT441701Medicaid
MTM000002328Medicare PIN