Provider Demographics
NPI:1346395191
Name:LEEDS AMBULANCE SERVICE
Entity Type:Organization
Organization Name:LEEDS AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RIO
Authorized Official - Middle Name:
Authorized Official - Last Name:HIMLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-466-2872
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:ND
Mailing Address - Zip Code:58346-0361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:ND
Practice Address - Zip Code:58346
Practice Address - Country:US
Practice Address - Phone:701-466-2619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND7107OtherBLUE CROSS BLUE SHIELD
ND590012618OtherRAILROAD MEDICARE
ND50119Medicaid
ND590012618OtherRAILROAD MEDICARE
590012618Medicare PIN