Healthcare Provider Details

I. General information

NPI: 1689697062
Provider Name (Legal Business Name): WEST TRAILL AMBULANCE SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 7TH AVE SE
MAYVILLE ND
58257
US

IV. Provider business mailing address

PO BOX 545
MAYVILLE ND
58257-0545
US

V. Phone/Fax

Practice location:
  • Phone: 701-371-2827
  • Fax: 888-964-8168
Mailing address:
  • Phone: 701-371-2827
  • Fax: 888-964-8168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number77
License Number StateND

VIII. Authorized Official

Name: STEFAN HOFER
Title or Position: PRESIDENT
Credential:
Phone: 701-371-2827