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General NPI Number Information
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NPI Number | 1851451207
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Entity Type | Organization
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Legal Business Name | GRANT-ROBERTS AMBULANCE INC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 305 E RAILWAY AVE
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City | MILBANK
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State | SD
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Zip | 57252-1322
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Country | US
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Telephone | 605-432-6783
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 623
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City | MILBANK
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State | SD
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Zip | 57252-0623
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Country | US
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Telephone | 605-432-6783
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BARRET JAY WICKLUND
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Credential |
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Telephone | 218-739-5875
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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 | 0291
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License Number State | SD
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