Provider Demographics
NPI:1477659860
Name:LARIMORE AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:LARIMORE AMBULANCE SERVICE INC
Other - Org Name:LARIMORE AMBULANCE AND RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:NREMTI
Authorized Official - Phone:701-343-6293
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:LARIMORE
Mailing Address - State:ND
Mailing Address - Zip Code:58251-0365
Mailing Address - Country:US
Mailing Address - Phone:701-343-6293
Mailing Address - Fax:701-343-6497
Practice Address - Street 1:420 TOWNER AVE
Practice Address - Street 2:
Practice Address - City:LARIMORE
Practice Address - State:ND
Practice Address - Zip Code:58251-0365
Practice Address - Country:US
Practice Address - Phone:701-343-6293
Practice Address - Fax:701-343-6497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0693416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND051238Medicaid
ND59009589OtherRAIL ROAD MEDICARE
ND051238Medicaid