MEDICARE: MEDS-1 AMBULANCE SERVICE

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

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	:	1861583130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDS-1 AMBULANCE SERVICE

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

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

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WILLIAM KEVIN MCNICHOLS
Credential	:
Telephone Number	:	218-326-0020

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	05/27/2016

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Directions to “MEDS-1 AMBULANCE SERVICE ” Practice Location

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