Basic Information
| Provider Information | |||||||||
| NPI: | 1912573965 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SHC 2021 LLC | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| OtherOrganizationName: | SIDNEY HEALTH CENTER CARE FLIGHT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 216 14TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | SIDNEY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 592703519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064882117 | ||||||||
| FaxNumber: | 4064882115 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 14TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | SIDNEY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 592703519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064882117 | ||||||||
| FaxNumber: | 4064882115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2021 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MONTGOMERY | ||||||||
| AuthorizedOfficialFirstName: | TINA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 4064882117 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416A0800X | Y | Transportation Services | Ambulance | Air Transport |
No ID Information.