Active NPI
Wilton Ambulance Service
- Ambulance
- Wilton, ND
National Provider Identifier
1255410841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulance
- License
- 133
- Legal business name
- WILTON AMBULANCE SERVICE
- Practice address
- 117 Dakota Ave
Wilton, ND 58579-0163 - Phone
- (701) 734-6247
- Fax
- (701) 734-6247
- NPI assigned
- Nov 3, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Leeann R Domonoske
- Title
- Ambulance Coordinator
- Phone
- (701) 734-6247
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 133 | ND | Primary |
Addresses
Primary practice location
117 Dakota Ave
Wilton, ND 58579-0163
Mailing address
PO Box 974
Mandan, ND 58554-0974
Phone (701) 250-6361
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50397 | Medicaid | ND | |
| WIL7618 | Other | ND | BLUE CROSS NORTH DAKOTA |
Other names 1
- WILTON RURAL AMBULANCE DISTRICT
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040630000066 | ND | Part B Supplier - Ambulance Service Supplier | 8729065644 | Practice locations: Wilton, ND |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1363132800000",
"number": "1255410841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 974",
"city": "MANDAN",
"state": "ND",
"postal_code": "585540974",
"telephone_number": "701-250-6361",
"fax_number": "701-255-7247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 DAKOTA AVE",
"city": "WILTON",
"state": "ND",
"postal_code": "585790163",
"telephone_number": "701-734-6247",
"fax_number": "701-734-6247"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WILTON AMBULANCE SERVICE",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-03",
"last_updated": "2013-03-13",
"status": "A",
"authorized_official_last_name": "DOMONOSKE",
"authorized_official_first_name": "LEEANN",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "AMBULANCE COORDINATOR",
"authorized_official_telephone_number": "701-734-6247",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "341600000X",
"taxonomy_group": "",
"desc": "Ambulance",
"state": "ND",
"license": "133",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "50397",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS NORTH DAKOTA",
"identifier": "WIL7618",
"state": "ND"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "WILTON RURAL AMBULANCE DISTRICT",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Wilton, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.