Provider Demographics
NPI:1609968122
Name:MCHENRY AMBULANCE
Entity Type:Organization
Organization Name:MCHENRY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-676-2702
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:BINFORD
Mailing Address - State:ND
Mailing Address - Zip Code:58416-0054
Mailing Address - Country:US
Mailing Address - Phone:701-676-2702
Mailing Address - Fax:701-676-2703
Practice Address - Street 1:178 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:ND
Practice Address - Zip Code:58464
Practice Address - Country:US
Practice Address - Phone:701-785-2513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND79341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN7642OtherMEDICARE ID