Healthcare Provider Details

I. General information

NPI: 1134129836
Provider Name (Legal Business Name): CENTERVILLE COMMUNITY AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MAIN STREET BOX 181
CENTERVILLE SD
57014-0181
US

IV. Provider business mailing address

PO BOX 181 800 MAIN
CENTERVILLE SD
57014-0181
US

V. Phone/Fax

Practice location:
  • Phone: 605-563-2842
  • Fax: 605-563-2804
Mailing address:
  • Phone: 605-563-2842
  • Fax: 605-563-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number611
License Number StateSD

VIII. Authorized Official

Name: DEBRA A PETERSEN
Title or Position: SECRETARY - TREASURER/BILLING MANGR
Credential:
Phone: 605-563-2842