Healthcare Provider Details

I. General information

NPI: 1801896162
Provider Name (Legal Business Name): TIOGA FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 10/27/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N. WELO ST
TIOGA ND
58852-0451
US

IV. Provider business mailing address

PO BOX 451
TIOGA ND
58852-0451
US

V. Phone/Fax

Practice location:
  • Phone: 701-664-5757
  • Fax: 701-664-3424
Mailing address:
  • Phone: 701-664-3305
  • Fax: 701-664-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number118
License Number StateND

VIII. Authorized Official

Name: RANDALL K. PEDERSON
Title or Position: TREASURER
Credential:
Phone: 701-664-5757