1902012404 NPI number — DIVIDE COUNTY AMBULANCE DISTRICT

Table of content: (NPI 1902012404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902012404 NPI number — DIVIDE COUNTY AMBULANCE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVIDE COUNTY AMBULANCE DISTRICT
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:
1902012404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 WEST CENTRAL AVE
Provider Second Line Business Mailing Address:
PO BOX 31
Provider Business Mailing Address City Name:
CROSBY
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58730-0031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-965-6321
Provider Business Mailing Address Fax Number:
701-965-4444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 1ST ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSBY
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58730-3329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-713-6038
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SWANSON
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
EMS OPERATIONS MANAGER
Authorized Official Telephone Number:
701-713-6038

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  027 , 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: 7105 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 50290 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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