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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