Provider Demographics
NPI:1861582884
Name:PARK RIVER VOLUNTEER AMBULANCE
Entity type:Organization
Organization Name:PARK RIVER VOLUNTEER AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:G
Authorized Official - Last Name:STAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-284-6675
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:PARK RIVER
Mailing Address - State:ND
Mailing Address - Zip Code:58270-0106
Mailing Address - Country:US
Mailing Address - Phone:701-284-6280
Mailing Address - Fax:701-284-6228
Practice Address - Street 1:115 VIVIAN STREET
Practice Address - Street 2:
Practice Address - City:PARK RIVER
Practice Address - State:ND
Practice Address - Zip Code:58270-0106
Practice Address - Country:US
Practice Address - Phone:701-284-6280
Practice Address - Fax:701-284-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND7142OtherBLUE CROSS BLUE SHIELD
ND050464Medicaid
ND050464Medicaid