Pembina Ambulance Service

Primary specialty

AmbulanceTaxonomy code 341600000X

License

103 Issued in ND

Legal business name

PEMBINA AMBULANCE SERVICE

Practice address

152 W Rolette St Ste 3
Pembina, ND 58271-4442

Phone

(701) 825-6868

NPI assigned

Oct 9, 2006

Last updated

Jan 14, 2010By 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

Brian Williams

Title

Secretary / Treasurer

Phone

(701) 825-6868

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Locations

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263427200000",
    "number": "1801983028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 131",
            "city": "PEMBINA",
            "state": "ND",
            "postal_code": "582710131",
            "telephone_number": "701-825-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 W ROLETTE ST STE 3",
            "city": "PEMBINA",
            "state": "ND",
            "postal_code": "582714442",
            "telephone_number": "701-825-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMBINA AMBULANCE SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2010-01-14",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "SECRETARY / TREASURER",
        "authorized_official_telephone_number": "701-825-6868"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "ND",
            "license": "103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51223",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "11320",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590013486",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jody Lynn Clow
• Suzanne M Leonard
• Teresa Sheri Ranson

• Ambulance in Pembina, ND
• Providers in Pembina, ND by specialty
• Ambulance in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; 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.