Provider Demographics
NPI:1669533394
Name:VALLEY AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:VALLEY AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:RESTEMAYER
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT PARAMEDIC
Authorized Official - Phone:701-352-3128
Mailing Address - Street 1:1317 GRIGGS AVENUE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237
Mailing Address - Country:US
Mailing Address - Phone:701-352-3128
Mailing Address - Fax:701-352-1176
Practice Address - Street 1:1317 GRIGGS AVENUE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237
Practice Address - Country:US
Practice Address - Phone:701-352-3128
Practice Address - Fax:701-352-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0047341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND51301Medicaid