Provider Demographics
NPI:1174737712
Name:CITY OF WILLISTON
Entity type:Organization
Organization Name:CITY OF WILLISTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HERCULES
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-572-3400
Mailing Address - Street 1:317 11TH STREET W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5127
Mailing Address - Country:US
Mailing Address - Phone:701-572-3400
Mailing Address - Fax:701-572-6602
Practice Address - Street 1:317 11TH ST W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801
Practice Address - Country:US
Practice Address - Phone:701-572-3400
Practice Address - Fax:701-572-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1313416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND8375OtherBCBS ND
MT440700Medicaid
ND1451862Medicaid
7008OtherOTHER INSURANCE
ND8375OtherBCBS ND
ND791590193Medicare ID - Type UnspecifiedPALMETTO RR MC