Provider Demographics
NPI:1902012404
Name:DIVIDE COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:DIVIDE COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-713-6038
Mailing Address - Street 1:107 WEST CENTRAL AVE
Mailing Address - Street 2:PO BOX 31
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730-0031
Mailing Address - Country:US
Mailing Address - Phone:701-965-6321
Mailing Address - Fax:701-965-4444
Practice Address - Street 1:702 1ST ST SW
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730-3329
Practice Address - Country:US
Practice Address - Phone:701-713-6038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0273416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND7105OtherBLUE CROSS BLUE SHIELD
ND50290Medicaid
ND7105OtherBLUE CROSS BLUE SHIELD