Polson Ambulance, Inc.

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

158 Issued in MT

Legal business name

POLSON AMBULANCE, INC.

Practice address

904 2ND St E
Polson, MT 59860-3031

Phone

(406) 883-5778

Fax

(406) 883-9433

NPI assigned

Jun 6, 2006

Organization subpart

No

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

Authorized official

Name

John R Ungaretti, CCEMTP

Title

General Manager

Phone

(406) 549-7104

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404259200000",
    "number": "1558300228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 BURLINGTON AVE STE C",
            "address_2": "PO BOX 1359",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598061359",
            "telephone_number": "406-549-7104",
            "fax_number": "406-542-2785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 2ND ST E",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598603031",
            "telephone_number": "406-883-5778",
            "fax_number": "406-883-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLSON AMBULANCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-06",
        "last_updated": "2014-07-02",
        "status": "A",
        "authorized_official_last_name": "UNGARETTI",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "406-549-7104",
        "authorized_official_credential": "CCEMTP"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "MT",
            "license": "158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206313",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9040866",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002244000",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0443274",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1402",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jedidiah Allen Petersen, PA
• Susan M Peterson, R.N.
• Lacey J Phelan, DPT
• Richard Pierre, CPHT
• Malgorzata Podraza, O.D.
• Polson Chiropractic LLC
• Polson Family Chiropractic Inc.
• Polson School District 23
• Polson Senior Center
• Polson SNF Operations, LLC

• Land Ambulance in Polson, MT
• Providers in Polson, MT by specialty
• Land Ambulance in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.