Provider Demographics
NPI:1164592184
Name:KIDDER COUNTY AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:KIDDER COUNTY AMBULANCE SERVICE INC
Other - Org Name:KIDDER COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:701-475-2595
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-0974
Mailing Address - Country:US
Mailing Address - Phone:701-250-6361
Mailing Address - Fax:
Practice Address - Street 1:120 N MITCHELL
Practice Address - Street 2:
Practice Address - City:STEELE
Practice Address - State:ND
Practice Address - Zip Code:58482
Practice Address - Country:US
Practice Address - Phone:701-475-2595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND117341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDKID10702OtherBLUE CROSS
ND52701Medicaid
ND52701Medicaid
NDKID10702OtherBLUE CROSS