Provider Demographics
NPI:1205926730
Name:ESMOND COMMUNITY AMBULANCE SERVICE
Entity type:Organization
Organization Name:ESMOND COMMUNITY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ARLICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-249-3370
Mailing Address - Street 1:216 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:ESMOND
Mailing Address - State:ND
Mailing Address - Zip Code:58332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:216 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:ESMOND
Practice Address - State:ND
Practice Address - Zip Code:58332
Practice Address - Country:US
Practice Address - Phone:701-249-3230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND034341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND59013524OtherRAILROAD MEDICARE
ND7662OtherBLUE CROSS BLUE SHIELD
ND53781Medicaid
ND59013524OtherRAILROAD MEDICARE