Provider Demographics
NPI:1578623930
Name:HUNTER AMBULANCE SERVICE
Entity Type:Organization
Organization Name:HUNTER AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-874-2161
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-0974
Mailing Address - Country:US
Mailing Address - Phone:701-250-6361
Mailing Address - Fax:701-255-7247
Practice Address - Street 1:401 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTER
Practice Address - State:ND
Practice Address - Zip Code:58048-4003
Practice Address - Country:US
Practice Address - Phone:701-874-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND593416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND51468Medicaid
ND7275OtherBLUE CROSS BLUE SHIELD
ND7275OtherBLUE CROSS BLUE SHIELD