Provider Demographics
NPI:1679692800
Name:GOLDEN VALLEY AMBULANCE SERVICE
Entity type:Organization
Organization Name:GOLDEN VALLEY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:406-568-2251
Mailing Address - Street 1:104 KEMP STREET
Mailing Address - Street 2:P.O. BOX 55
Mailing Address - City:RYEGATE
Mailing Address - State:MT
Mailing Address - Zip Code:59074
Mailing Address - Country:US
Mailing Address - Phone:406-568-2251
Mailing Address - Fax:406-568-2528
Practice Address - Street 1:104 KEMP STREET
Practice Address - Street 2:
Practice Address - City:RYEGATE
Practice Address - State:MT
Practice Address - Zip Code:59074
Practice Address - Country:US
Practice Address - Phone:406-568-2251
Practice Address - Fax:406-568-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT157146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty