Basic Information
| Provider Information | |||||||||
| NPI: | 1316582315 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POWELL EMERGENCY MEDICAL SERVICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 HOLLENBECK LN | ||||||||
| Address2: | |||||||||
| City: | DEER LODGE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597222317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064151034 | ||||||||
| FaxNumber: | 4068462789 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 HOLLENBECK LN | ||||||||
| Address2: | |||||||||
| City: | DEER LODGE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597222317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064151034 | ||||||||
| FaxNumber: | 4068462789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2019 | ||||||||
| LastUpdateDate: | 01/28/2020 | ||||||||
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| AuthorizedOfficialLastName: | SPRING | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | JO | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4064151034 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 01/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
No ID Information.