Healthcare Provider Details

I. General information

NPI: 1487683306
Provider Name (Legal Business Name): HUMBOLDT FIRE & AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W 2ND AVE
HUMBOLDT SD
57035
US

IV. Provider business mailing address

321 W 2ND AVE
HUMBOLDT SD
57035
US

V. Phone/Fax

Practice location:
  • Phone: 877-882-9911
  • Fax: 877-882-9922
Mailing address:
  • Phone: 877-882-9911
  • Fax: 877-882-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number013
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier9011340
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: MRS. MICHELE SMITH
Title or Position: ACCOUNT REPRESENTATIVE
Credential:
Phone: 877-882-9911