Healthcare Provider Details

I. General information

NPI: 1245534668
Provider Name (Legal Business Name): ALTRU SPECIALTY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 4TH AVENUE NORTHEAST SUITE B
DEVILS LAKE ND
58301
US

IV. Provider business mailing address

1200 SOUTH COLUMBIA ROAD
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-544-2100
  • Fax:
Mailing address:
  • Phone: 701-780-5888
  • Fax: 701-780-5849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JODY ANDERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 701-780-5888