Provider Demographics
NPI:1649323114
Name:MINNEWAUKAN AMBULANCE SERVICE
Entity type:Organization
Organization Name:MINNEWAUKAN AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TRAINING OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-473-5419
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:MINNEWAUKAN
Mailing Address - State:ND
Mailing Address - Zip Code:58351-0043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:160 MAIN ST E.
Practice Address - Street 2:
Practice Address - City:MINNEWAUKAN
Practice Address - State:ND
Practice Address - Zip Code:58351
Practice Address - Country:US
Practice Address - Phone:701-473-2531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0873416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND56811Medicaid
ND7098OtherBLUE CROSS BLUE SHIELD
NDN7098Medicare ID - Type Unspecified