Provider Demographics
NPI:1952481822
Name:POWERS LAKE AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:POWERS LAKE AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SQUAD LEADER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-464-5566
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:POWERS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58773
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 RAILROAD AVE WEST
Practice Address - Street 2:
Practice Address - City:POWERS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58773
Practice Address - Country:US
Practice Address - Phone:701-464-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND106341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54256Medicaid
ND590014467OtherRAILROAD MEDICARE
ND7151OtherBLUE CROSS BLUE SHIELD
ND7151OtherBLUE CROSS BLUE SHIELD
NDN7151Medicare PIN
ND54256Medicaid