Healthcare Provider Details

I. General information

NPI: 1518056423
Provider Name (Legal Business Name): UNDERWOOD AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 GRANT AVE
UNDERWOOD ND
58576-1045
US

IV. Provider business mailing address

PO BOX 974
MANDAN ND
58554-0974
US

V. Phone/Fax

Practice location:
  • Phone: 701-442-5773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number121
License Number StateND

VIII. Authorized Official

Name: DELILA REPNOW
Title or Position: SECRETARY
Credential:
Phone: 701-442-5773