Healthcare Provider Details

I. General information

NPI: 1972530475
Provider Name (Legal Business Name): ALCESTER AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W 2ND ST
ALCESTER SD
57001
US

IV. Provider business mailing address

106 W 2ND ST
ALCESTER SD
57001
US

V. Phone/Fax

Practice location:
  • Phone: 605-882-9911
  • Fax: 605-882-9922
Mailing address:
  • Phone: 605-882-9911
  • Fax: 605-882-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number34-11
License Number StateSD

VIII. Authorized Official

Name: MRS. MICHELE SMITH
Title or Position: ACCOUNT REPRESENTATIVE
Credential:
Phone: 605-882-9911