Healthcare Provider Details

I. General information

NPI: 1548334246
Provider Name (Legal Business Name): MED STAR PARAMEDIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 E REDWOOD BLVD
BRANDON SD
57005
US

IV. Provider business mailing address

PO BOX 512 922 E REDWOOD BLVD
BRANDON SD
57005
US

V. Phone/Fax

Practice location:
  • Phone: 605-582-6096
  • Fax: 605-582-8983
Mailing address:
  • Phone: 605-582-6096
  • Fax: 605-582-8983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number0015
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JUDITH C ZIMMERMAN
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 605-582-6096