Park City Ambulance Service

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

105 Issued in MT

Legal business name

PARK CITY AMBULANCE SERVICE

Practice address

102 1St Ave SW
Park City, MT 59063

Phone

(406) 633-2345

Fax

(406) 633-2015

NPI assigned

May 2, 2006

Last updated

Oct 24, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Myron Gross

Title

Board Director

Phone

(406) 633-9898

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MT

Enrollment records 1

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540339200000",
    "number": "1730147430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 292",
            "city": "PARK CITY",
            "state": "MT",
            "postal_code": "59063",
            "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": "102 1ST AVE SW",
            "city": "PARK CITY",
            "state": "MT",
            "postal_code": "59063",
            "telephone_number": "406-633-2345",
            "fax_number": "406-633-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK CITY AMBULANCE SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2018-10-24",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "MYRON",
        "authorized_official_title_or_position": "BOARD DIRECTOR",
        "authorized_official_telephone_number": "406-633-9898",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "MT",
            "license": "105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "65102",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0446511",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Dickson, PHARM D
• School District No 5
• Maurice Camp Smith, MD

• Land Ambulance in Park City, MT
• Providers in Park City, MT by specialty
• Land Ambulance in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.