Provider Demographics
NPI:1104913904
Name:WYNDMERE BARNEY RURAL AMBULANCE DIST
Entity type:Organization
Organization Name:WYNDMERE BARNEY RURAL AMBULANCE DIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUEBKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-439-2780
Mailing Address - Street 1:403 ASH AVE.
Mailing Address - Street 2:PO BOX 184
Mailing Address - City:WYNDMERE
Mailing Address - State:ND
Mailing Address - Zip Code:58081-0184
Mailing Address - Country:US
Mailing Address - Phone:701-439-2780
Mailing Address - Fax:701-439-2781
Practice Address - Street 1:403 ASH AVE
Practice Address - Street 2:
Practice Address - City:WYNDMERE
Practice Address - State:ND
Practice Address - Zip Code:58081
Practice Address - Country:US
Practice Address - Phone:701-439-2780
Practice Address - Fax:701-439-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1363416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55269Medicaid
NDN7084Medicare PIN