Provider Demographics
NPI:1275639064
Name:WING AMBULANCE SERVICE, INC
Entity Type:Organization
Organization Name:WING AMBULANCE SERVICE, INC
Other - Org Name:WING RURAL AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-943-2672
Mailing Address - Street 1:25401 227TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WING
Mailing Address - State:ND
Mailing Address - Zip Code:58494-9613
Mailing Address - Country:US
Mailing Address - Phone:701-943-2672
Mailing Address - Fax:
Practice Address - Street 1:25401 227TH AVE NE
Practice Address - Street 2:
Practice Address - City:WING
Practice Address - State:ND
Practice Address - Zip Code:58494-9613
Practice Address - Country:US
Practice Address - Phone:701-943-2672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1343416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDWIN7053OtherND BLUE CROSS
ND57794Medicaid
ND590095562Medicare PIN
NDWIN7053OtherND BLUE CROSS