MEDICARE: SPEARFISH EMERGENCY AMBULANCE SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343800000X	Secured Medical Transport (VAN)	0092	SD
2	3416L0300X	Land Ambulance	0092	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0099162	OTHER	SD	WELLMARK BCBS OF SD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336130434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEARFISH EMERGENCY AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	715 E COLORADO BLVD
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783-2702
Country	:	US
Telephone Number	:	605-642-8810
Fax Number	:	605-717-0193

Provider Business Practice Location Address
First Line	:	715 E COLORADO BLVD
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783-2702
Country	:	US
Telephone Number	:	605-642-8810
Fax Number	:	605-717-0193

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. BRIAN S HAMBEK
Credential	:	NREMT-P
Telephone Number	:	605-642-8810

Provider Enumeration Date	:	10/30/2005
Last Update Date	:	04/12/2017

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Directions to “SPEARFISH EMERGENCY AMBULANCE SERVICE ” Practice Location

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