MEDICARE: ALTRU SPECIALTY SERVICES, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1932547023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTRU SPECIALTY SERVICES, INC

Provider Business Mailing Address
First Line	:	1200 S COLUMBIA RD
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-4036
Country	:	US
Telephone Number	:	701-780-2500
Fax Number	:	701-780-4395

Provider Business Practice Location Address
First Line	:	4350 S WASHINGTON ST
Second Line	:	SUITE 104
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-7184
Country	:	US
Telephone Number	:	701-780-2436
Fax Number	:	701-780-1643

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JODY A. ANDERSON
Credential	:
Telephone Number	:	701-780-1542

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	02/06/2014

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