MEDICARE: MEDS-1 AMBULANCE SERVICE INC

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	3416L0300X	Land Ambulance	0319	MN

General Provider Information

NPI Number	:	1265884456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDS-1 AMBULANCE SERVICE INC

Provider Business Mailing Address
First Line	:	1328 NW 5TH ST
Second Line	:
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744-2245
Country	:	US
Telephone Number	:	218-326-0020
Fax Number	:	218-326-1402

Provider Business Practice Location Address
First Line	:	1328 NW 5TH ST
Second Line	:
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744-2245
Country	:	US
Telephone Number	:	218-326-0020
Fax Number	:	218-326-1402

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	MR. JAMES RICHARD DUCHARME
Credential	:	NREMTP
Telephone Number	:	218-326-0020

Provider Enumeration Date	:	07/12/2016
Last Update Date	:	07/12/2016

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