Healthcare Provider Details

I. General information

NPI: 1760539100
Provider Name (Legal Business Name): MADDOCK AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 LINCOLN AVE
MADDOCK ND
58348-0208
US

IV. Provider business mailing address

PO BOX 208
MADDOCK ND
58348-0208
US

V. Phone/Fax

Practice location:
  • Phone: 701-438-2319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number074
License Number StateND

VIII. Authorized Official

Name: JOYCE RASMUSSEN
Title or Position: SECRETARY TREASURER
Credential:
Phone: 701-438-2319