Healthcare Provider Details

I. General information

NPI: 1518056142
Provider Name (Legal Business Name): MCKENZIE COUNTY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 3RD AVE NE
WATFORD CITY ND
58854
US

IV. Provider business mailing address

PO BOX 974
MANDAN ND
58554-0974
US

V. Phone/Fax

Practice location:
  • Phone: 701-842-6364
  • Fax:
Mailing address:
  • Phone: 701-250-6361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number129
License Number StateND

VIII. Authorized Official

Name: KARI KRIKAVA
Title or Position: SQUAD LEADER
Credential:
Phone: 701-842-6364