Healthcare Provider Details

I. General information

NPI: 1528023231
Provider Name (Legal Business Name): AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MINNESOTA AVE
BRECKENRIDGE MN
56520-1946
US

IV. Provider business mailing address

PO BOX 64
BRECKENRIDGE MN
56520-0064
US

V. Phone/Fax

Practice location:
  • Phone: 218-643-2636
  • Fax: 218-643-2637
Mailing address:
  • Phone: 218-643-2636
  • Fax: 218-643-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number18
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0034
License Number StateMN

VIII. Authorized Official

Name: MR. THOMAS M VERTIN
Title or Position: PRESIDENT
Credential:
Phone: 218-643-2636