Basic Information
| Provider Information | |||||||||
| NPI: | 1376583914 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BIG SANDY VOLUNTEER FIRE DEPARTMENT & AMBULAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 157 | ||||||||
| Address2: | |||||||||
| City: | BIG SANDY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 595200157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063782188 | ||||||||
| FaxNumber: | 4063782180 | ||||||||
| Practice Location | |||||||||
| Address1: | 258 JUDITH LANDING ROAD | ||||||||
| Address2: | |||||||||
| City: | BIG SANDY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 595200157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063782188 | ||||||||
| FaxNumber: | 4063782180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | BOLD | ||||||||
| AuthorizedOfficialFirstName: | HARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 4063782188 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | MT | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 1376583914 | 05 | MT | MEDICAID | 065482 | 01 | MT | BLUE CROSS/BLUE SHIELD | OTHER | 0000065482 | 01 | MT | BLUE CROSS/SHIELD | OTHER |