Organization
MOHALL AMBULANCE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE WITTEMAN (PRESIDENT)
(701) 756-7156
Entity
Organization
Contact information
Practice address
105 MAIN ST WEST, MOHALL, ND 58761
(701) 756-7159
Mailing address
105 MAIN ST WEST, MOHALL, ND 58761
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
089
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56732
—
ND
01
—
59006107
RAILROAD MEDICARE
ND
01
—
7021
BLUE CROSS BLUE SHIELD
ND
Enumeration date
10/13/2006
Last updated
08/22/2020
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