Lidgerwood Rural Ambulance Service
Organization Active NPI Ambulance · Lidgerwood, ND
NPI 1295896934 · NPPES record last updated Aug 8, 2018
Key facts
- NPI
- 1295896934
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulance 341600000X
- License
- 071 (ND)
- Legal business name
- LIDGERWOOD RURAL AMBULANCE SERVICE
- Practice address
- 146 Wiley Ave S
Lidgerwood, ND 58053 - Phone
- (701) 538-4344
- NPI assigned
- Dec 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Sandy Fossum
- Title
- Manager
- Phone
- (701) 538-4344
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 35D1016162 | Lidgerwood Ambulance | Certificate of waiver | Feb 21, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060505000539 | ND | Part B Supplier - Ambulance Service Supplier | 1153332101 | Practice locations: Lidgerwood, ND |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 071 | ND | Yes |
Addresses
Primary practice location
146 Wiley Ave S
Lidgerwood, ND 58053
Mailing address
PO Box 416
Lidgerwood, ND 58053-0416
Phone (701) 538-4350
Other practice location 1
109 Park St. W.
Lidgerwood, ND 58053-0416
Phone (701) 538-4350
Other names
- Lidgerwood Rural Ambulance Service District
- Lidgerwood Ambulance Service
Other providers in Lidgerwood, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.