Provider Demographics
NPI:1548366248
Name:ELK RIVER FIRE & AMBULANCE SERVICE
Entity type:Organization
Organization Name:ELK RIVER FIRE & AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DITTBENNER
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:763-441-2733
Mailing Address - Street 1:415 JACKSON AVE NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1327
Mailing Address - Country:US
Mailing Address - Phone:763-441-2733
Mailing Address - Fax:763-441-4050
Practice Address - Street 1:415 JACKSON AVE NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1327
Practice Address - Country:US
Practice Address - Phone:763-441-2733
Practice Address - Fax:763-441-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0733416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8180255OtherMEDICA PRIMARY
MN106310OtherU-CARE
MN1007550OtherPREFERRED ONE
MN8181676OtherMEDICA CHOICE
MN38849ELOtherBLUE CROSS