Healthcare Provider Details

I. General information

NPI: 1497962393
Provider Name (Legal Business Name): KENMARE AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N CENTRAL AVE
KENMARE ND
58746
US

IV. Provider business mailing address

PO BOX 817
KENMARE ND
58746-0817
US

V. Phone/Fax

Practice location:
  • Phone: 701-509-6285
  • Fax:
Mailing address:
  • Phone: 701-509-6285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number061
License Number StateND

VIII. Authorized Official

Name: SARA STASKYWICZ
Title or Position: SECRETARY TREASURER
Credential:
Phone: 701-385-4488