Provider Demographics
NPI:1184624264
Name:CITY OF HAVRE
Entity type:Organization
Organization Name:CITY OF HAVRE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-265-6511
Mailing Address - Street 1:520 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-3650
Mailing Address - Country:US
Mailing Address - Phone:406-268-5651
Mailing Address - Fax:406-265-5088
Practice Address - Street 1:520 4TH ST
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3650
Practice Address - Country:US
Practice Address - Phone:406-268-5651
Practice Address - Fax:406-265-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT044-8162Medicaid
MT6516 2OtherBLUE CROSS BLUE SHIELD
MT044-8162Medicaid