MEDICARE: BISMARCK AIR MEDICAL, LLC

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	3416A0800X	Air Ambulance	604	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	BIS23241	OTHER	ND	BLUE CROSS ND

General Provider Information

NPI Number	:	1255337333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BISMARCK AIR MEDICAL, LLC

Provider Business Mailing Address
First Line	:	2301 UNIVERSITY DR BLDG 53
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-7595
Country	:	US
Telephone Number	:	701-225-4754
Fax Number	:

Provider Business Practice Location Address
First Line	:	2940 N 19TH ST
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58503-5393
Country	:	US
Telephone Number	:	701-255-0812
Fax Number	:	701-255-7247

Authorized Official
Title or Position	:	OWNER
Name	:	JONATHAN SIMMERS
Credential	:
Telephone Number	:	701-225-4754

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	06/12/2025

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