Provider Demographics
NPI:1861583130
Name:MEDS-1 AMBULANCE SERVICE
Entity type:Organization
Organization Name:MEDS-1 AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:MCNICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-326-0020
Mailing Address - Street 1:1328 NW 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744
Mailing Address - Country:US
Mailing Address - Phone:218-326-0020
Mailing Address - Fax:218-326-1402
Practice Address - Street 1:1328 NW 5TH STREET
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744
Practice Address - Country:US
Practice Address - Phone:218-326-0020
Practice Address - Fax:218-326-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN03193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN280268600Medicaid
MN599000085Medicare ID - Type Unspecified