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General NPI Number Information
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NPI Number | 1982794939
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Entity Type | Organization
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Legal Business Name | CITY OF PLAZA
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 409 4TH AVE COVELL ST
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City | PLAZA
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State | ND
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Zip | 58771-0057
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Country | US
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Telephone | 701-497-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 409 4TH AVE COVELL ST BOX 57
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City | PLAZA
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State | ND
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Zip | 58771-0057
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Country | US
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Telephone | 701-720-3311
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Fax |
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Authorized Official
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Title or Position | SERVICE LEADER MANAGER
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Name | GARY L. JOHNSON
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Credential | EMT B
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Telephone | 701-497-3766
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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 | 104
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License Number State | ND
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