Healthcare Provider Details

I. General information

NPI: 1932421062
Provider Name (Legal Business Name): HUMBOLDT FIRE & AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W 2ND AVE
HUMBOLDT SD
57035-2044
US

IV. Provider business mailing address

PO BOX 227
HUMBOLDT SD
57035-0227
US

V. Phone/Fax

Practice location:
  • Phone: 605-363-3100
  • Fax:
Mailing address:
  • Phone: 605-363-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0013
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier99015
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerWELLMARK, BCBS
# 2
Identifier9011340
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: SUSAN SHUMAKER
Title or Position: ASST AMBULANCE DIRECTOR
Credential: EMT-P
Phone: 605-363-3100