Provider Demographics
NPI:1467665513
Name:WALHALLA AMBULANCE SERVICE
Entity type:Organization
Organization Name:WALHALLA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER-WALHALLA AMBULANCE SER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLAIRMONT
Authorized Official - Suffix:
Authorized Official - Credentials:WALHALLA AMBULANCE S
Authorized Official - Phone:701-549-2609
Mailing Address - Street 1:P.O. BOX 467
Mailing Address - Street 2:1309 DELANO AVENUE
Mailing Address - City:WALHALLA
Mailing Address - State:ND
Mailing Address - Zip Code:58282
Mailing Address - Country:US
Mailing Address - Phone:701-549-2609
Mailing Address - Fax:701-549-2625
Practice Address - Street 1:1309 DELANO AVENUE
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:ND
Practice Address - Zip Code:58282
Practice Address - Country:US
Practice Address - Phone:701-549-2609
Practice Address - Fax:701-549-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1273416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND53936Medicaid
ND7695OtherBLUE CROSS BLUE SHIELD
ND590006699OtherRAILROAD MEDICARE
ND590006699OtherRAILROAD MEDICARE