Provider Demographics
NPI:1801983028
Name:PEMBINA AMBULANCE SERVICE
Entity type:Organization
Organization Name:PEMBINA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY / TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-825-6868
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:PEMBINA
Mailing Address - State:ND
Mailing Address - Zip Code:58271-0131
Mailing Address - Country:US
Mailing Address - Phone:701-825-6868
Mailing Address - Fax:
Practice Address - Street 1:152 W ROLETTE ST STE 3
Practice Address - Street 2:
Practice Address - City:PEMBINA
Practice Address - State:ND
Practice Address - Zip Code:58271-4442
Practice Address - Country:US
Practice Address - Phone:701-825-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND103341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND590013486OtherRAILROAD MEDICARE
ND51223Medicaid
ND11320OtherBLUE CROSS BLUE SHIELD
NDN7700Medicare ID - Type Unspecified