MEDICARE: CITY OF CARSON/CARSON AMBULANCE SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	022	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1897001	OTHER	ND	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164594479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF CARSON/CARSON AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	100 S MAIN ST
Second Line	:
City	:	CARSON
State	:	ND
Zip	:	58529-4002
Country	:	US
Telephone Number	:	701-622-3395
Fax Number	:	701-622-3909

Provider Business Practice Location Address
First Line	:	100 S MAIN ST
Second Line	:
City	:	CARSON
State	:	ND
Zip	:	58529-4002
Country	:	US
Telephone Number	:	701-622-3395
Fax Number	:	701-622-3909

Authorized Official
Title or Position	:	CITY AUDITOR
Name	:	MS. SONJA A SPRENGER
Credential	:
Telephone Number	:	701-622-3395

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	10/26/2009

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