Healthcare Provider Details

I. General information

NPI: 1497071708
Provider Name (Legal Business Name): ISABEL-DEWEY COUNTY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N. MAIN ST
ISABEL SD
57633
US

IV. Provider business mailing address

PO BOX 641880
OMAHA NE
68164-7880
US

V. Phone/Fax

Practice location:
  • Phone: 402-572-4019
  • Fax: 402-965-8594
Mailing address:
  • Phone: 402-572-4019
  • Fax: 402-965-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0242
License Number StateNE

VII. Legacy identifiers

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

# 1
IdentifierPENDING
Identifier TypeMEDICAID
Identifier StateNE
Identifier Issuer
# 2
IdentifierPENDING
Identifier TypeOTHER
Identifier StateNE
Identifier IssuerBCBS

VIII. Authorized Official

Name: RONALD STRADINGER
Title or Position: CHAIRMAN
Credential:
Phone: 402-572-4019