Organization
LAKESIDE QRU, INC
Active
Organization
LAKESIDE QRU, INC
Active
Other names
Upper West Shore Quick Response Unit
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN OWEN (EXECUTIVE DIRECTOR)
(406) 844-2775
Entity
Organization
Contact information
Practice address
201 BILLS RD, LAKESIDE, MT 59922
(406) 844-2775
(406) 844-3663
Mailing address
PO BOX 2458, EUREKA, MT 59917-2458
(406) 297-1627
(406) 297-4144
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
152
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0442238
—
MT
01
—
65762
BLUE CROSS BLUE SHIELD
MT
01
—
657682
BC BS
MT
Enumeration date
06/06/2006
Last updated
05/19/2020
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