Provider Demographics
NPI:1487814687
Name:MCCLUSKY AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:MCCLUSKY AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-363-2368
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:MCCLUSKY
Mailing Address - State:ND
Mailing Address - Zip Code:58463-0622
Mailing Address - Country:US
Mailing Address - Phone:701-363-2368
Mailing Address - Fax:
Practice Address - Street 1:113 AVE B EAST
Practice Address - Street 2:
Practice Address - City:MCCLUSKY
Practice Address - State:ND
Practice Address - Zip Code:58463-0000
Practice Address - Country:US
Practice Address - Phone:701-363-2368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0783416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN7101Medicare PIN