Healthcare Provider Details

I. General information

NPI: 1861581779
Provider Name (Legal Business Name): RIVERDALE AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 DAKOTA AVE
RIVERDALE ND
58565-0594
US

IV. Provider business mailing address

PO BOX 974
MANDAN ND
58554-0974
US

V. Phone/Fax

Practice location:
  • Phone: 704-654-7466
  • Fax:
Mailing address:
  • Phone: 701-255-0812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number110
License Number StateND

VIII. Authorized Official

Name: MS. DINAH HINSZ
Title or Position: TREASURER
Credential:
Phone: 701-654-7466