Healthcare Provider Details

I. General information

NPI: 1104900604
Provider Name (Legal Business Name): RICHARDTON RURAL FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S MAIN ST
RICHARDTON ND
58652-7204
US

IV. Provider business mailing address

PO BOX 351
RICHARDTON ND
58652-0351
US

V. Phone/Fax

Practice location:
  • Phone: 701-260-3645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number109
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier55642
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer
# 2
Identifier590006950
Identifier TypeOTHER
Identifier StateND
Identifier IssuerRAILROAD MEDICARE
# 3
Identifier7128
Identifier TypeOTHER
Identifier StateND
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name: LEA FLOBERG
Title or Position: OPERATIONS OFFICER
Credential:
Phone: 701-974-4101