Healthcare Provider Details

I. General information

NPI: 1578889523
Provider Name (Legal Business Name): BURKE AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 WASHINGTON STREET
BURKE SD
57523-0061
US

IV. Provider business mailing address

PO BOX 61 701 WASHINGTON STREET
BURKE SD
57523-0061
US

V. Phone/Fax

Practice location:
  • Phone: 605-830-2221
  • Fax: 605-775-9055
Mailing address:
  • Phone: 605-775-9055
  • Fax: 605-775-9055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0302
License Number StateSD

VIII. Authorized Official

Name: MARK GREEN
Title or Position: VICE PRESIDENT
Credential:
Phone: 605-830-2221