Provider Demographics
NPI:1699714352
Name:PHILLIPS COUNTY
Entity type:Organization
Organization Name:PHILLIPS COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER / NREMT
Authorized Official - Prefix:
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:SAMUEL JOHN
Authorized Official - Last Name:ABRAHAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT
Authorized Official - Phone:406-654-2336
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:MT
Mailing Address - Zip Code:59538-0289
Mailing Address - Country:US
Mailing Address - Phone:406-654-2336
Mailing Address - Fax:406-654-2940
Practice Address - Street 1:314 S 2ND W
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:MT
Practice Address - Zip Code:59538
Practice Address - Country:US
Practice Address - Phone:406-654-2336
Practice Address - Fax:406-654-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0583416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0447720Medicaid
MT1672OtherBCBS
SD9011070Medicaid
WA9047630Medicaid
MT590059244OtherRAILRAOD MEDICARE
SD9011070Medicaid