Basic Information
| Provider Information | |||||||||
| NPI: | 1568449528 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RUGBY EMERGENCY AMBULANCE SERVICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 S MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | RUGBY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 583682118 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 S MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | RUGBY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 583682118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017765455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 10/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | VOELLER | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 7017765261 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 114 | ND | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 590009407 | 01 | ND | RAILROAD MEDICARE | OTHER | 50077 | 05 | ND | MEDICAID | 7083 | 01 | ND | BLUE CROSS BLUE SHIELD ND | OTHER |