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General NPI Number Information
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NPI Number | 1548286875
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Entity Type | Organization
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Legal Business Name | WAGNER-LAKE ANDES AMBULANCE DISTRICT
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 455 E MAIN ST.
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City | LAKE ANDES
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State | SD
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Zip | 57356-0758
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Country | US
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Telephone | 605-487-6177
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Fax | 605-487-6177
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Provider Business Mailing Address
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Address Line | PO BOX 758
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City | LAKE ANDES
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State | SD
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Zip | 57356-0758
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Country | US
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Telephone | 605-487-6177
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Fax | 605-487-6177
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. B STEINMARK
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Credential |
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Telephone | 605-487-6177
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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 | 0171 AND 0173
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License Number State | SD
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