Elk River Fire & Ambulance Service

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

073 Issued in MN

Legal business name

ELK RIVER FIRE & AMBULANCE SERVICE

Practice address

415 Jackson Ave NW
Elk River, MN 55330-1327

Phone

(763) 441-2733

Fax

(763) 441-4050

NPI assigned

Sep 16, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Steven Lee Dittbenner, PARAMEDIC

Title

Ambulance Coordinator

Phone

(763) 441-2733

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1548366248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 JACKSON AVE NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301327",
            "telephone_number": "763-441-2733",
            "fax_number": "763-441-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 JACKSON AVE NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301327",
            "telephone_number": "763-441-2733",
            "fax_number": "763-441-4050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK RIVER FIRE & AMBULANCE SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DITTBENNER",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "AMBULANCE COORDINATOR",
        "authorized_official_telephone_number": "763-441-2733",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PARAMEDIC"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "MN",
            "license": "073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PRIMARY",
            "identifier": "8180255",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U-CARE",
            "identifier": "106310",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1007550",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CHOICE",
            "identifier": "8181676",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "38849EL",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Land Ambulance in Elk River, MN
• Providers in Elk River, MN by specialty
• Land Ambulance in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.

Verify at the official NPI Registry.