Provider Demographics
NPI:1053431155
Name:ALMONT AMBULANCE SERVICE
Entity type:Organization
Organization Name:ALMONT AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LY NNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-843-7589
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-0974
Mailing Address - Country:US
Mailing Address - Phone:701-250-6361
Mailing Address - Fax:
Practice Address - Street 1:MAIN STREET
Practice Address - Street 2:
Practice Address - City:ALMONT
Practice Address - State:ND
Practice Address - Zip Code:58520
Practice Address - Country:US
Practice Address - Phone:701-843-7589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50856Medicaid
NDALM30162OtherBLUE CROSS OF ND
NDALM30162OtherBLUE CROSS OF ND