Provider Demographics
NPI:1851491641
Name:GARRISON AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:GARRISON AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:MELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-463-2178
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:ND
Mailing Address - Zip Code:58540-0517
Mailing Address - Country:US
Mailing Address - Phone:701-463-2178
Mailing Address - Fax:701-463-2190
Practice Address - Street 1:202 5TH ST SE
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:ND
Practice Address - Zip Code:58540-7212
Practice Address - Country:US
Practice Address - Phone:701-463-2172
Practice Address - Fax:701-463-2190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND043341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND590095371OtherRAILROAD MEDICARE
7690OtherBLUE CROSS BLUE SHIELD
ND50710Medicaid
ND50710Medicaid