Provider Demographics
NPI:1194825976
Name:BOWDON AMBULANCE SERVICE
Entity Type:Organization
Organization Name:BOWDON AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-962-3697
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:211 WARRINGTON AVE
Mailing Address - City:BOWDON
Mailing Address - State:ND
Mailing Address - Zip Code:58418-0027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 WARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:BOWDON
Practice Address - State:ND
Practice Address - Zip Code:58418-9998
Practice Address - Country:US
Practice Address - Phone:701-962-3646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND016341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND59064Medicaid
ND7007OtherBLUE CROSS BLUE SHIELD
ND7007OtherBLUE CROSS BLUE SHIELD