Provider Demographics
NPI:1679591929
Name:EMERGENCY AMBULANCE OF DEVILS LAKE
Entity type:Organization
Organization Name:EMERGENCY AMBULANCE OF DEVILS LAKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ROED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-662-8832
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-0893
Mailing Address - Country:US
Mailing Address - Phone:701-662-8832
Mailing Address - Fax:701-662-7385
Practice Address - Street 1:804 5TH ST SE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3802
Practice Address - Country:US
Practice Address - Phone:701-662-8832
Practice Address - Fax:701-662-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50115Medicaid
NDN7035Medicare PIN