=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588735401
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELFIELD AMBULANCE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 11/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 304 MAIN ST S
-----------------------------------------------------
City | BELFIELD
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-575-4234
-----------------------------------------------------
Fax | 701-575-4234
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 933
-----------------------------------------------------
City | BELFIELD
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58622-0933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SQUAD LEADER
-----------------------------------------------------
Name | SUSANN WOLF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 701-575-4004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 005
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------