Provider Demographics
NPI:1104495720
Name:POWDER RIVER COUNTY
Entity type:Organization
Organization Name:POWDER RIVER COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF EMS
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-436-2361
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:BROADUS
Mailing Address - State:MT
Mailing Address - Zip Code:59317-0200
Mailing Address - Country:US
Mailing Address - Phone:406-436-2361
Mailing Address - Fax:
Practice Address - Street 1:201 E HOLT ST
Practice Address - Street 2:
Practice Address - City:BROADUS
Practice Address - State:MT
Practice Address - Zip Code:59317-9502
Practice Address - Country:US
Practice Address - Phone:406-436-2361
Practice Address - Fax:406-436-2151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POWDER RIVER COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-18
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport