1164594479 NPI number — CITY OF CARSON/CARSON 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 1164594479 NPI number — CITY OF CARSON/CARSON AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CARSON/CARSON 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:
1164594479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58529-4002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-622-3395
Provider Business Mailing Address Fax Number:
701-622-3909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARSON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58529-4002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-622-3395
Provider Business Practice Location Address Fax Number:
701-622-3909
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPRENGER
Authorized Official First Name:
SONJA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CITY AUDITOR
Authorized Official Telephone Number:
701-622-3395

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  022 , 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: 1897001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 57827 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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