Provider Demographics
NPI:1356665962
Name:FESSENDEN AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:FESSENDEN AMBULANCE DISTRICT
Other - Org Name:FESSENDEN AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-547-3319
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:FESSENDEN
Mailing Address - State:ND
Mailing Address - Zip Code:58438-0193
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:602 RAILWAY ST N
Practice Address - Street 2:
Practice Address - City:FESSENDEN
Practice Address - State:ND
Practice Address - Zip Code:58438
Practice Address - Country:US
Practice Address - Phone:701-547-3319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND00363416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55788Medicaid
ND55788Medicaid