Organization
CITY OF ELLENDALE
Active
Other names
ELLENDALE COMMUNITY AMBULANCE SERVICE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COREY ERWIN GULKE NREMT-P (MANAGER)
(701) 349-3364
Entity
Organization
Contact information
Practice address
55 3RD AVE S, ELLENDALE, ND 58436
(701) 349-3364
(701) 349-3333
Mailing address
PO BOX 267, ELLENDALE, ND 58436-0267
(701) 349-3364
(701) 349-3333
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
33
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2955-001
BC-BS PROVIDER
ND
05
—
52179
—
ND
01
—
590095437
RAILROAD MEDICARE PROVIDE
ND
01
—
9010790
SD MEDICAID PROVIDER
SD
Enumeration date
01/11/2007
Last updated
07/02/2008
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