Healthcare Provider Details

I. General information

NPI: 1548366925
Provider Name (Legal Business Name): AVON SAVE A LIFE AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E 1ST AVE
AVON SD
57315-0207
US

IV. Provider business mailing address

BOX 207 116 N MAIN ST
AVON SD
57315-0207
US

V. Phone/Fax

Practice location:
  • Phone: 605-286-3694
  • Fax: 605-286-3694
Mailing address:
  • Phone: 605-286-3694
  • Fax: 605-286-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. CAROL L BERNDT
Title or Position: CITY FINANCE OFFICER
Credential:
Phone: 605-286-3694