Healthcare Provider Details

I. General information

NPI: 1629072590
Provider Name (Legal Business Name): CASSELTON AMBULANCE SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 6TH AVE S
CASSELTON ND
58012-3533
US

IV. Provider business mailing address

101 6TH AVE S
CASSELTON ND
58012-3533
US

V. Phone/Fax

Practice location:
  • Phone: 701-347-4004
  • Fax: 701-347-4004
Mailing address:
  • Phone: 701-347-4004
  • Fax: 701-347-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number023
License Number StateND

VIII. Authorized Official

Name: MR. KENNETH G HABIGER
Title or Position: PRESIDENT
Credential:
Phone: 701-347-4004