Provider Demographics
NPI:1558581918
Name:MCVILLE COMMUNITY AMBULANCE SERVICES
Entity Type:Organization
Organization Name:MCVILLE COMMUNITY AMBULANCE SERVICES
Other - Org Name:MCVILLE AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:TWEED
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:701-262-4934
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:MCVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58254-0343
Mailing Address - Country:US
Mailing Address - Phone:701-322-4328
Mailing Address - Fax:
Practice Address - Street 1:118 W MCDOUGALL AVE
Practice Address - Street 2:
Practice Address - City:MCVILLE
Practice Address - State:ND
Practice Address - Zip Code:58254
Practice Address - Country:US
Practice Address - Phone:701-322-4328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND082341600000X
ND823416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50087Medicaid
ND50087Medicaid