Healthcare Provider Details

I. General information

NPI: 1730279720
Provider Name (Legal Business Name): TURTLE LAKE AMBULANCE SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 PUTNAM STREET
TURTLE LAKE ND
58575-0243
US

IV. Provider business mailing address

PO BOX 243
TURTLE LAKE ND
58575-0243
US

V. Phone/Fax

Practice location:
  • Phone: 701-448-2518
  • Fax: 701-448-2518
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0120
License Number StateND

VIII. Authorized Official

Name: DAVID ROBERT HANSON
Title or Position: SQUAD LEADER
Credential:
Phone: 701-448-9288