Organization
AMBULANCE SERVICE INC
Active
Organization
AMBULANCE SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R UNGARETTI CCEMTP (GENERAL MANAGER)
(406) 549-7104
Entity
Organization
Contact information
Practice address
510 OAK ST, NEZ PERCE, ID 83543
(208) 937-9909
(208) 937-9787
Mailing address
1008 BURLINGTON AVE STE C, PO BOX 1359, MISSOULA, MT 59806-1359
(406) 549-7104
(406) 542-2785
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
7204
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015169
REGENT BLUE SHIELD
ID
05
—
9054727
—
WA
01
—
E1003
BCBS
ID
Enumeration date
06/06/2006
Last updated
08/22/2020
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