Healthcare Provider Details

I. General information

NPI: 1205962909
Provider Name (Legal Business Name): CAVALIER AMBULANCE SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 2ND AVE N
CAVALIER ND
58220-4207
US

IV. Provider business mailing address

PO BOX 231
CAVALIER ND
58220-0231
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-8259
  • Fax: 701-265-3746
Mailing address:
  • Phone: 701-265-8259
  • Fax: 701-265-3746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number24
License Number StateND

VIII. Authorized Official

Name: LISA LETEXIER
Title or Position: BOARD PRESIDENT
Credential:
Phone: 701-265-6228