Provider Demographics
NPI:1528023231
Name:AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:VERTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-643-2636
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520-0064
Mailing Address - Country:US
Mailing Address - Phone:218-643-2636
Mailing Address - Fax:218-643-2637
Practice Address - Street 1:120 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1946
Practice Address - Country:US
Practice Address - Phone:218-643-2636
Practice Address - Fax:218-643-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00343416L0300X
ND183416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50766Medicaid
ND7932OtherBLUE CROSS
MN501267800Medicaid
MN62042AMOtherBLUE CROSS
MN501267800Medicaid
ND7932OtherBLUE CROSS
ND7921Medicare ID - Type Unspecified