Healthcare Provider Details

I. General information

NPI: 1467675967
Provider Name (Legal Business Name): BERESFORD COMMUNITY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NORTH 10TH ST
BERESFORD SD
57004
US

IV. Provider business mailing address

50 N KNOLL DR APT 1
SIOUX FALLS SD
57110-6434
US

V. Phone/Fax

Practice location:
  • Phone: 605-763-2100
  • Fax:
Mailing address:
  • Phone: 605-310-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number621
License Number StateSD

VIII. Authorized Official

Name: ROBERT C JAMES
Title or Position: PRESIDENT OF THE BOARD
Credential:
Phone: 605-253-2275