MEDICARE: STANDING ROCK PUBLIC TRANSPORTATION

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	343800000X	Secured Medical Transport (VAN)	SBC 202	ND

General Provider Information

NPI Number	:	1972731974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANDING ROCK PUBLIC TRANSPORTATION

Provider Business Mailing Address
First Line	:	1341 92ND STREET
Second Line	:
City	:	FORT YATES
State	:	ND
Zip	:	58538
Country	:	US
Telephone Number	:	701-854-8090
Fax Number	:	701-854-3061

Provider Business Practice Location Address
First Line	:	1341 92ND STREET
Second Line	:
City	:	FORT YATES
State	:	ND
Zip	:	58538
Country	:	US
Telephone Number	:	701-854-8090
Fax Number	:	701-854-3061

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PAM TERNES
Credential	:
Telephone Number	:	701-854-8010

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

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Directions to “STANDING ROCK PUBLIC TRANSPORTATION ” Practice Location

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