North Dakota Code § 23-27-01

License required - Licensing of emergency medical services operations -
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Exception - Waiver.
1. The department of health and human services shall license emergency medical 
services operations and may designate their service areas. The department shall limit 
the issuance of a license for any new emergency medical services operation based on 
the needs of the service area. A license for an emergency medical services operation 
is transferable upon approval of the department.
2. Emergency medical services may not be advertised, offered, or provided to the public 
except by an emergency medical services operator that provides the emergency 
medical services through emergency medical services personnel.
3. An emergency medical services operation must be separately licensed for each of the 
designated service area of the operation . Under this subsection, an operation may 
position vehicles and emergency medical services personnel at more than one 
location within the designated service area of an emergency medical services 
operation.
4. Notwithstanding subsection 3, an operator of an emergency medical services 
operation may operate one or more substation ambulance services operations under a 
single license if:
a. The substation ambulance services operation was designated before 
December 31, 2024, and remains continuously designated;
b. The headquarters ambulance services operation is not a substation ambulance 
services operation of another emergency medical services operation;
c. The substation ambulance services operation area borders the headquarters 
ambulance services operation area or borders another substation of the 
headquarters ambulance services operation;
d. The headquarters ambulance services operation and the substation ambulance 
services operation are dispatched by the same entity; and
e. The operator of the emergency medical services operation pays a license fee for 
each of its substation ambulance services operations.
5. The provisions of this chapter do not apply to an operator from another state which is 
headquartered at a location outside of this state and transports patients across state 
lines, but the operator may not treat patients within this state or pick up patients within 
this state for transportation to locations within this state, except as provided by rule.
6. The department of health and human services shall adopt rules for special licenses 
and waiver provisions for an operator of an emergency medical services operation 
intended for industrial sites not available to the general public.

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