Provider Demographics
NPI:1932292505
Name:BENNINGTON AMBULANCE SERVICE
Entity Type:Organization
Organization Name:BENNINGTON AMBULANCE SERVICE
Other - Org Name:OTTAWA COUNTY FIRE DISTRICT #4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SWETSON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-I
Authorized Official - Phone:785-488-3768
Mailing Address - Street 1:584 N. 180TH ROAD
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67422
Mailing Address - Country:US
Mailing Address - Phone:785-488-3768
Mailing Address - Fax:785-488-3375
Practice Address - Street 1:584 N. 180TH ROAD
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:KS
Practice Address - Zip Code:67422
Practice Address - Country:US
Practice Address - Phone:785-488-3768
Practice Address - Fax:785-488-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS150341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100091580BMedicaid
KS100091580BMedicaid