Provider Demographics
NPI:1578622999
Name:DICKINSON AREA AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:DICKINSON AREA AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRET
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-225-1500
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58602-0772
Mailing Address - Country:US
Mailing Address - Phone:701-225-1500
Mailing Address - Fax:701-225-1500
Practice Address - Street 1:42 B AVENUE E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5354
Practice Address - Country:US
Practice Address - Phone:701-225-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND293416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54345Medicaid
ND7020OtherBLUE CROSS BLUE SHIELD
ND54345Medicaid