Active NPI
City of Ellendale
- Land Ambulance
- Ellendale, ND
National Provider Identifier
1609926013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- License
- 33
- Legal business name
- CITY OF ELLENDALE
- Practice address
- 55 3Rd Ave S
Ellendale, ND 58436 - Phone
- (701) 349-3364
- Fax
- (701) 349-3333
- NPI assigned
- Jan 11, 2007
- 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
- Mr. Corey Erwin Gulke, NREMT-P
- Title
- Manager
- Phone
- (701) 349-3364
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 33 | ND | Primary |
Addresses
Primary practice location
55 3Rd Ave S
Ellendale, ND 58436
Mailing address
PO Box 267
Ellendale, ND 58436-0267
Phone (701) 349-3364
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2955-001 | Other | ND | BC-BS PROVIDER |
| 590095437 | Other | ND | RAILROAD MEDICARE PROVIDE |
| 52179 | Medicaid | ND | |
| 9010790 | Other | SD | SD MEDICAID PROVIDER |
Other names 1
- ELLENDALE COMMUNITY AMBULANCE SERVICE
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091222000217 | ND | Part B Supplier - Ambulance Service Supplier | 2769522861 | Practice locations: Ellendale, ND |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1214956800000",
"number": "1609926013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 267",
"city": "ELLENDALE",
"state": "ND",
"postal_code": "584360267",
"telephone_number": "701-349-3364",
"fax_number": "701-349-3333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 3RD AVE S",
"city": "ELLENDALE",
"state": "ND",
"postal_code": "58436",
"telephone_number": "701-349-3364",
"fax_number": "701-349-3333"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CITY OF ELLENDALE",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-11",
"last_updated": "2008-07-02",
"status": "A",
"authorized_official_last_name": "GULKE",
"authorized_official_first_name": "COREY",
"authorized_official_middle_name": "ERWIN",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "701-349-3364",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "NREMT-P"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "ND",
"license": "33",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC-BS PROVIDER",
"identifier": "2955-001",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE PROVIDE",
"identifier": "590095437",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "52179",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SD MEDICAID PROVIDER",
"identifier": "9010790",
"state": "SD"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "ELLENDALE COMMUNITY AMBULANCE SERVICE",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Ellendale, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; 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.