Healthcare Provider Details

I. General information

NPI: 1104913904
Provider Name (Legal Business Name): WYNDMERE BARNEY RURAL AMBULANCE DIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 ASH AVE
WYNDMERE ND
58081
US

IV. Provider business mailing address

403 ASH AVE. PO BOX 184
WYNDMERE ND
58081-0184
US

V. Phone/Fax

Practice location:
  • Phone: 701-439-2780
  • Fax: 701-439-2781
Mailing address:
  • Phone: 701-439-2780
  • Fax: 701-439-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number136
License Number StateND

VIII. Authorized Official

Name: MS. RONDA J LUEBKE
Title or Position: OFFICE MANAGER
Credential:
Phone: 701-439-2780