Healthcare Provider Details

I. General information

NPI: 1932278892
Provider Name (Legal Business Name): ROLETTE AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 MAIN ST
ROLETTE ND
58366
US

IV. Provider business mailing address

PO BOX 565
ROLETTE ND
58366-0565
US

V. Phone/Fax

Practice location:
  • Phone: 701-246-3531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number112
License Number StateND

VIII. Authorized Official

Name: TAMERA TUENGE
Title or Position: MANAGER
Credential:
Phone: 701-246-3531