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General NPI Number Information
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NPI Number | 1902012404
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Entity Type | Organization
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Legal Business Name | DIVIDE COUNTY AMBULANCE DISTRICT
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 702 1ST ST SW
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City | CROSBY
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State | ND
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Zip | 58730-3329
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Country | US
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Telephone | 701-713-6038
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Fax |
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Provider Business Mailing Address
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Address Line | 107 WEST CENTRAL AVE PO BOX 31
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City | CROSBY
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State | ND
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Zip | 58730-0031
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Country | US
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Telephone | 701-965-6321
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Fax | 701-965-4444
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Authorized Official
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Title or Position | EMS OPERATIONS MANAGER
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Name | TIMOTHY D SWANSON
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Credential |
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Telephone | 701-713-6038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 027
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License Number State | ND
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