Healthcare Provider Details

I. General information

NPI: 1609032838
Provider Name (Legal Business Name): PERKINS COUNTY AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W MAIN
BISON SD
57620
US

IV. Provider business mailing address

PO BOX 156
BISON SD
57620-0156
US

V. Phone/Fax

Practice location:
  • Phone: 605-244-5550
  • Fax:
Mailing address:
  • Phone: 605-244-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0531
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier1609032838
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerWELLMARK, BCBS
# 2
Identifier1609032838
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: MICHELE SMITH
Title or Position: ACCOUNT REPRESENTATIVE
Credential:
Phone: 605-793-9911