Healthcare Provider Details

I. General information

NPI: 1568538072
Provider Name (Legal Business Name): GARRETSON COMMUNITY AMBULANCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 N MAIN AVE
GARRETSON SD
57030
US

IV. Provider business mailing address

638 N MAIN AVE
GARRETSON SD
57030
US

V. Phone/Fax

Practice location:
  • Phone: 605-594-2043
  • Fax: 605-594-2084
Mailing address:
  • Phone: 605-594-2043
  • Fax: 605-594-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0012
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier9001002
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: MR. KURTIS NELSON
Title or Position: AMBULANCE DIRECTOR
Credential:
Phone: 605-594-2043