Provider Demographics
NPI:1588726780
Name:THOMPSON FALLS AMBULANCE
Entity type:Organization
Organization Name:THOMPSON FALLS AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER - BILLING CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-827-3446
Mailing Address - Street 1:PO BOX 1055
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-1055
Mailing Address - Country:US
Mailing Address - Phone:406-827-4536
Mailing Address - Fax:406-827-4536
Practice Address - Street 1:5011 HWY 200
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873
Practice Address - Country:US
Practice Address - Phone:406-827-4536
Practice Address - Fax:406-827-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2009-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM000002270OtherMEDICARE PTAN