Healthcare Provider Details

I. General information

NPI: 1245383587
Provider Name (Legal Business Name): YODER AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 MAIN STREET
YODER WY
82244-0011
US

IV. Provider business mailing address

PO BOX 220
YODER WY
82244-0011
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-1397
  • Fax:
Mailing address:
  • Phone:
  • Fax: 307-532-3326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number85
License Number StateWY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BOB GLADSON
Title or Position: AMBULANCE DIRECTOR
Credential:
Phone: 307-532-1397