Provider Demographics
NPI:1457405698
Name:DRAYTON VOLUNTEER AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:DRAYTON VOLUNTEER AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUNCKLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-454-6119
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:DRAYTON
Mailing Address - State:ND
Mailing Address - Zip Code:58225-0238
Mailing Address - Country:US
Mailing Address - Phone:701-454-6505
Mailing Address - Fax:701-454-3817
Practice Address - Street 1:105 GRANT AVE
Practice Address - Street 2:
Practice Address - City:DRAYTON
Practice Address - State:ND
Practice Address - Zip Code:58225-0238
Practice Address - Country:US
Practice Address - Phone:701-454-6505
Practice Address - Fax:701-454-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND7302OtherBLUE CROSS BLUE SHIELD
ND51616Medicaid
ND51616Medicaid