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General NPI Number Information
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NPI Number | 1306037817
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Entity Type | Organization
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Legal Business Name | TEN SLEEP AMBULANCE SERVICE
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 415 5TH STREET
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City | TEN SLEEP
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State | WY
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Zip | 82442-0005
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Country | US
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Telephone | 307-366-2265
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Fax | 307-366-2228
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Provider Business Mailing Address
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Address Line | PO BOX 5
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City | TEN SLEEP
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State | WY
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Zip | 82442-0005
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Country | US
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Telephone | 307-366-2265
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Fax | 307-366-2228
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Authorized Official
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Title or Position | DIRECTOR
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Name | GARD DEREK FERGUSON
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Credential | EMT-I
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Telephone | 307-431-5148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 76
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License Number State | WY
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