Healthcare Provider Details

I. General information

NPI: 1699841981
Provider Name (Legal Business Name): WHITE AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N LINCOLN AVE
WHITE SD
57276
US

IV. Provider business mailing address

107 N LINCOLN AVE PO BOX 93
WHITE SD
57276
US

V. Phone/Fax

Practice location:
  • Phone: 605-882-9911
  • Fax: 605-882-9922
Mailing address:
  • Phone: 605-882-9911
  • Fax: 605-882-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0063
License Number StateSD

VIII. Authorized Official

Name: MRS. MICHELE SMITH
Title or Position: ACCOUNT REPRESENTATIVE
Credential:
Phone: 605-882-9911