1215030598 NPI number — GRASS RANGE QUICK RESPONSE UNIT INC

Table of content: (NPI 1215030598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215030598 NPI number — GRASS RANGE QUICK RESPONSE UNIT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRASS RANGE QUICK RESPONSE UNIT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GRASS RANGE AMBULANCE SERVICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215030598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 842
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRASS RANGE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59032-0842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 NO MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRASS RANGE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59032-8081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-428-2362
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STAHL
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR/PRESIDENT
Authorized Official Telephone Number:
406-428-2362

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0440258 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12-00457-8 . This is a "WORKERS COMP-STATE OF MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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