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General NPI Number Information
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NPI Number | 1497875306
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Entity Type | Organization
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Legal Business Name | BURKE AMBULANCE SERVICE, INC.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 701 WASHINGTON STREET
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City | BURKE
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State | SD
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Zip | 57523-0061
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Country | US
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Telephone | 605-775-9055
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Fax | 605-775-9055
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Provider Business Mailing Address
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Address Line | PO BOX 61
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City | BURKE
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State | SD
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Zip | 57523-0061
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Country | US
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Telephone | 605-775-9055
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Fax | 605-775-9055
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DEBRA KAREN LEIBEL
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Credential | CNP
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Telephone | 605-775-9055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 0302
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License Number State | SD
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