Healthcare Provider Details

I. General information

NPI: 1336130434
Provider Name (Legal Business Name): SPEARFISH EMERGENCY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2005
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E COLORADO BLVD
SPEARFISH SD
57783-2702
US

IV. Provider business mailing address

715 E COLORADO BLVD
SPEARFISH SD
57783-2702
US

V. Phone/Fax

Practice location:
  • Phone: 605-642-8810
  • Fax: 605-717-0193
Mailing address:
  • Phone: 605-642-8810
  • Fax: 605-717-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0092
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number0092
License Number StateSD

VIII. Authorized Official

Name: MR. BRIAN S HAMBEK
Title or Position: EXECUTIVE DIRECTOR
Credential: NREMT-P
Phone: 605-642-8810