Lakeside Qru, Inc
Organization Active NPI Land Ambulance · Lakeside, MT
NPI 1205875978 · NPPES record last updated May 19, 2020
Key facts
- NPI
- 1205875978
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 152 (MT)
- Legal business name
- LAKESIDE QRU, INC
- Practice address
- 201 Bills Rd
Lakeside, MT 59922 - Phone
- (406) 844-2775
- Fax
- (406) 844-3663
- NPI assigned
- Jun 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Jordan Owen
- Title
- Executive Director
- Phone
- (406) 844-2775
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040203001044 | MT | Part B Supplier - Ambulance Service Supplier | 3577456698 | Practice locations: Lakeside, MT; Kalispell, MT |
National Provider Directory
Locations
235 United Dr
Kalispell, MT 59901
Phone (406) 844-2775
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 152 | MT | Yes |
Addresses
Primary practice location
201 Bills Rd
Lakeside, MT 59922
Mailing address
PO Box 2458
Eureka, MT 59917-2458
Phone (406) 297-1627
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 657682 | Other | MT | BC BS |
| 65762 | Other | MT | BLUE CROSS BLUE SHIELD |
| 0442238 | Medicaid | MT |
Other names
- Upper West Shore Quick Response Unit
Other providers in Lakeside, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.