NPIMap

Organization Active NPI

Powder River County

  • Land Ambulance
  • Broadus, MT
National Provider Identifier
1104495720
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
Legal business name
POWDER RIVER COUNTY
Practice address
201 E Holt St
Broadus, MT 59317-9502
Phone
(406) 436-2361
Fax
(406) 436-2151
NPI assigned
Jun 18, 2021
Last updated
Jul 23, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
POWDER RIVER COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Adam W Johnson
Title
Director of EMS
Phone
(406) 436-2361

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X Primary

Addresses

Primary practice location

201 E Holt St
Broadus, MT 59317-9502

Mailing address

PO Box 200
Broadus, MT 59317-0200
Phone (406) 436-2361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210913001111 MT Part B Supplier - Ambulance Service Supplier 2860543667 Practice locations: Broadus, MT

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Powder River Med Clinic5 organizations share this tax ID, including this one
Part of
Powder River Med Clinic

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Powder River ManorBroadus, MT, CCN 275087 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Aug 1, 1977
Nov 20, 2013
Nov 20, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Powder River County

    dba Powder River Manor

    • Skilled Nursing Facility
    • Broadus, MT
    • NPI 1386611747

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1104495720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 200",
            "city": "BROADUS",
            "state": "MT",
            "postal_code": "593170200",
            "telephone_number": "406-436-2361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E HOLT ST",
            "city": "BROADUS",
            "state": "MT",
            "postal_code": "593179502",
            "telephone_number": "406-436-2361",
            "fax_number": "406-436-2151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POWDER RIVER COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POWDER RIVER COUNTY",
        "enumeration_date": "2021-06-18",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "DIRECTOR OF EMS",
        "authorized_official_telephone_number": "406-436-2361"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broadus, MT

Sources for this page

Verify at the official NPI Registry.