Provider Demographics
NPI:1518089499
Name:WEST RIVER HEALTH SERVICES
Entity Type:Organization
Organization Name:WEST RIVER HEALTH SERVICES
Other - Org Name:WEST RIVER AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-567-6184
Mailing Address - Street 1:1000 HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:HETTINGER
Mailing Address - State:ND
Mailing Address - Zip Code:58639-7530
Mailing Address - Country:US
Mailing Address - Phone:701-567-4561
Mailing Address - Fax:701-567-6361
Practice Address - Street 1:1000 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:HETTINGER
Practice Address - State:ND
Practice Address - Zip Code:58639-7530
Practice Address - Country:US
Practice Address - Phone:701-567-4561
Practice Address - Fax:701-567-6361
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST RIVER HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-04
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50783Medicaid
ND011882OtherBCBS OF NORTH DAKOTA
SD9010550Medicaid
SD9010550Medicaid