=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780734285
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRENORA AMBULANCE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2007
-----------------------------------------------------
Last Update Date | 01/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 MAIN STREET
-----------------------------------------------------
City | GRENORA
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58845-0274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-694-3391
-----------------------------------------------------
Fax | 701-694-3392
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 274
-----------------------------------------------------
City | GRENORA
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58845-0274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-694-3391
-----------------------------------------------------
Fax | 701-694-3391
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY SQUAD LEADER
-----------------------------------------------------
Name | JANE SCHENSTAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 701-694-3391
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 049
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------