Healthcare Provider Details

I. General information

NPI: 1609819127
Provider Name (Legal Business Name): LANGDON AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 2ND ST
LANGDON ND
58249-2407
US

IV. Provider business mailing address

909 2ND ST
LANGDON ND
58249-2407
US

V. Phone/Fax

Practice location:
  • Phone: 701-256-6100
  • Fax: 701-256-2170
Mailing address:
  • Phone: 701-256-6100
  • Fax: 701-256-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number67
License Number StateND

VIII. Authorized Official

Name: JEFFERY STANLEY
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 701-256-6100