Organization
SPIRIT LAKE TRIBE
Active
Other names
Spirit Lake EMS
Organization subpart
No
Provider details
NPI number
Authorized official
ELTON GREYWATER (MANAGER)
(701) 766-4223
Entity
Organization
Contact information
Practice address
7686 EPHRIAM HILL ROAD, FORT TOTTEN, ND 58335
(701) 766-4223
(701) 766-4878
Mailing address
PO BOX 480, FORT TOTTEN, ND 58335-0480
(701) 766-4223
(701) 766-4878
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
142
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
59890
—
ND
01
—
70727
BLUE CROSS PROVIDER
ND
05
—
A610023000
—
MN
Enumeration date
09/20/2006
Last updated
11/08/2018
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