Provider Demographics
NPI:1154396067
Name:COUNTY OF ROSEBUD
Entity type:Organization
Organization Name:COUNTY OF ROSEBUD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-748-3136
Mailing Address - Street 1:PO BOX 998
Mailing Address - Street 2:
Mailing Address - City:COLSTRIP
Mailing Address - State:MT
Mailing Address - Zip Code:59323-0998
Mailing Address - Country:US
Mailing Address - Phone:406-748-3136
Mailing Address - Fax:
Practice Address - Street 1:303 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COLSTRIP
Practice Address - State:MT
Practice Address - Zip Code:59323-0998
Practice Address - Country:US
Practice Address - Phone:406-748-3136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1303416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0440079Medicaid