=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588724553
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST MEDIC AMBULANCE SERVICE OF RANSOM COUNTY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 12/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 OAK ST
-----------------------------------------------------
City | LISBON
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-683-4721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 679
-----------------------------------------------------
City | MOORHEAD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56561-0679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-233-5658
-----------------------------------------------------
Fax | 218-233-7630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | BJORN RINGDAHL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 218-233-5658
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 73
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------