MEDICARE: TURTLE LAKE 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	341600000X	Ambulance	0120	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730279720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TURTLE LAKE AMBULANCE SERVICE, INC

Provider Business Mailing Address
First Line	:	PO BOX 243
Second Line	:
City	:	TURTLE LAKE
State	:	ND
Zip	:	58575-0243
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 PUTNAM STREET
Second Line	:
City	:	TURTLE LAKE
State	:	ND
Zip	:	58575-0243
Country	:	US
Telephone Number	:	701-448-2518
Fax Number	:	701-448-2518

Authorized Official
Title or Position	:	SQUAD LEADER
Name	:	DAVID ROBERT HANSON
Credential	:
Telephone Number	:	701-448-9288

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	02/26/2008

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