Glenburn Area Ambulance Service Incorporated

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

045 Issued in ND

Legal business name

GLENBURN AREA AMBULANCE SERVICE INCORPORATED

Practice address

104 3Rd Ave S
Glenburn, ND 58740-0095

Phone

(701) 263-5620

NPI assigned

Nov 15, 2006

Last updated

Feb 11, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Jodi Spokely

Title

Secretary/Treasurer

Phone

(701) 263-5620

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Glenburn Ambulance Other name

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423612800000",
    "number": "1598837346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95",
            "city": "GLENBURN",
            "state": "ND",
            "postal_code": "587400095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 3RD AVE S",
            "city": "GLENBURN",
            "state": "ND",
            "postal_code": "587400095",
            "telephone_number": "701-263-5620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENBURN AREA AMBULANCE SERVICE INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2015-02-11",
        "status": "A",
        "authorized_official_last_name": "SPOKELY",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "701-263-5620",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "ND",
            "license": "045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55617",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590008941",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "11239",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenburn Ambulance",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.