Provider Demographics
NPI:1376623124
Name:GOODRICH AMBULANCE SERVICE
Entity Type:Organization
Organization Name:GOODRICH AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-884-2727
Mailing Address - Street 1:141 19TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:ND
Mailing Address - Zip Code:58444-9373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 MCKINLEY
Practice Address - Street 2:
Practice Address - City:GOODRICH
Practice Address - State:ND
Practice Address - Zip Code:58444
Practice Address - Country:US
Practice Address - Phone:701-884-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND046341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDP00268227OtherRAILROAD MEDICARE
ND24770OtherBLUE CROSS BLUE SHIELD
ND56213Medicaid
NDN711286Medicare ID - Type Unspecified