Organization
POLSON AMBULANCE, 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
904 2ND ST E, POLSON, MT 59860-3031
(406) 883-5778
(406) 883-9433
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
158
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002244000
—
ID
05
—
0443274
—
MT
01
—
1402
BCBS
MT
05
—
206313
—
OR
05
—
9040866
—
WA
Enumeration date
06/06/2006
Last updated
07/02/2014
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