Healthcare Provider Details

I. General information

NPI: 1881766525
Provider Name (Legal Business Name): GLEN ULLIN AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 2ND ST SOUTH
GLEN ULLIN ND
58631
US

IV. Provider business mailing address

PO BOX 974
MANDAN ND
58554-0974
US

V. Phone/Fax

Practice location:
  • Phone: 701-348-3274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number44
License Number StateND

VIII. Authorized Official

Name: BRENDA DUPPONG
Title or Position: SQUAD LEADER
Credential:
Phone: 701-348-3274