1699817270 NPI number — BOTTINEAU AMBULANCE SERVICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699817270 NPI number — BOTTINEAU AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOTTINEAU AMBULANCE SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699817270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 93
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOTTINEAU
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58318-0093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-228-6904
Provider Business Mailing Address Fax Number:
701-228-6901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
323 BENNETT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOTTINEAU
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-228-6904
Provider Business Practice Location Address Fax Number:
701-228-6901
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAYKALLY
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
DEL TARNBURRINO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
701-228-6901

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0014 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 14 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 050160 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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