Portal Ambulance

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

105 Issued in ND

Legal business name

PORTAL AMBULANCE

Practice address

301 Clark St
Portal, ND 58772

Phone

(701) 839-6326

NPI assigned

Nov 15, 2006

Last updated

Jun 10, 2013By 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

Lisa Ann Knutson, EMT-I85

Title

Squad Leader

Phone

(701) 933-2878

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Portal International Ambulance Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370822400000",
    "number": "1962574848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 61",
            "city": "PORTAL",
            "state": "ND",
            "postal_code": "587520061",
            "telephone_number": "701-933-2878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 CLARK ST",
            "city": "PORTAL",
            "state": "ND",
            "postal_code": "58772",
            "telephone_number": "701-839-6326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAL AMBULANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2013-06-10",
        "status": "A",
        "authorized_official_last_name": "KNUTSON",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "SQUAD LEADER",
        "authorized_official_telephone_number": "701-933-2878",
        "authorized_official_credential": "EMT-I85"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "ND",
            "license": "105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50505",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590013588",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "7409",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portal International Ambulance",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Marlo D Jacobson
• Jessica Poe

• Land Ambulance in Portal, ND
• Providers in Portal, ND by specialty
• Land Ambulance in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.