Provider Demographics
NPI:1861581779
Name:RIVERDALE AMBULANCE SERVICE
Entity type:Organization
Organization Name:RIVERDALE AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HINSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-654-7466
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-0974
Mailing Address - Country:US
Mailing Address - Phone:701-255-0812
Mailing Address - Fax:
Practice Address - Street 1:301 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:ND
Practice Address - Zip Code:58565-0594
Practice Address - Country:US
Practice Address - Phone:704-654-7466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND53302Medicaid
NDRIV70208OtherBLUE CROSS
ND53302Medicaid
NDRIV70208OtherBLUE CROSS