Provider Demographics
NPI:1982793030
Name:OLIVER COUNTY AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:OLIVER COUNTY AMBULANCE ASSOCIATION
Other - Org Name:OLIVER COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER/BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-794-8770
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:ND
Mailing Address - Zip Code:58530-0397
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 MAIN ST. E.
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:ND
Practice Address - Zip Code:58530-0397
Practice Address - Country:US
Practice Address - Phone:701-794-8828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND52028Medicaid
NDOLI7441OtherBLUE CROSS BLUE SHIELD
NDOLI7441OtherBLUE CROSS BLUE SHIELD