Provider Demographics
NPI:1306037817
Name:TEN SLEEP AMBULANCE SERVICE
Entity Type:Organization
Organization Name:TEN SLEEP AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARD
Authorized Official - Middle Name:DEREK
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-I
Authorized Official - Phone:307-431-5148
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:TEN SLEEP
Mailing Address - State:WY
Mailing Address - Zip Code:82442-0005
Mailing Address - Country:US
Mailing Address - Phone:307-366-2265
Mailing Address - Fax:307-366-2228
Practice Address - Street 1:415 5TH STREET
Practice Address - Street 2:
Practice Address - City:TEN SLEEP
Practice Address - State:WY
Practice Address - Zip Code:82442-0005
Practice Address - Country:US
Practice Address - Phone:307-366-2265
Practice Address - Fax:307-366-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY763416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport