Healthcare Provider Details

I. General information

NPI: 1699817270
Provider Name (Legal Business Name): BOTTINEAU AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 BENNETT ST
BOTTINEAU ND
58318
US

IV. Provider business mailing address

PO BOX 93
BOTTINEAU ND
58318-0093
US

V. Phone/Fax

Practice location:
  • Phone: 701-228-6904
  • Fax: 701-228-6901
Mailing address:
  • Phone: 701-228-6904
  • Fax: 701-228-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0014
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number14
License Number StateND

VIII. Authorized Official

Name: MRS. KATIE DEL TARNBURRINO SAYKALLY
Title or Position: PRESIDENT
Credential: AEMT
Phone: 701-228-6901