MEDICARE: ARDOLF CONSTRUCTION SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1144986423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARDOLF CONSTRUCTION SERVICES LLC

Provider Business Mailing Address
First Line	:	1551 PLEASANT VIEW DR APT 201
Second Line	:
City	:	NORTH MANKATO
State	:	MN
Zip	:	56003-2424
Country	:	US
Telephone Number	:	507-995-1886
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 PLEASANT VIEW DR APT 201
Second Line	:
City	:	NORTH MANKATO
State	:	MN
Zip	:	56003-2424
Country	:	US
Telephone Number	:	507-995-1886
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	JOSHUA ARDOLF
Credential	:
Telephone Number	:	507-995-1886

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/11/2021

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