Provider Demographics
NPI:1770528606
Name:FM AMBULANCE SERVICE, INC
Entity type:Organization
Organization Name:FM AMBULANCE SERVICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-328-8380
Mailing Address - Street 1:2215 18TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5105
Mailing Address - Country:US
Mailing Address - Phone:701-234-1262
Mailing Address - Fax:
Practice Address - Street 1:2215 18TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5105
Practice Address - Country:US
Practice Address - Phone:701-364-1700
Practice Address - Fax:701-364-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01663416L0300X
ND563416L0300X
ND0353416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50012Medicaid
10525OtherHEALTHPARTNERS
141853000OtherUS DEPT LABOR WORK COMP
61180FMOtherMNBC
81-20887OtherMEDICA
7009OtherNDBC
MN991369600Medicaid
MN599000088Medicare PIN
ND50012Medicaid