Timber Lake Ambulance Service Inc
Organization Active NPI Land Ambulance · Timber Lake, SD
NPI 1043247679 · NPPES record last updated Apr 29, 2009
Key facts
- NPI
- 1043247679
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 0243 (SD)
- Legal business name
- TIMBER LAKE AMBULANCE SERVICE INC
- Practice address
- 900 Main St
Timber Lake, SD 57656 - Phone
- (402) 572-4019
- Fax
- (402) 965-8594
- NPI assigned
- Jun 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Miss Chris Hermes
- Title
- Treasurer
- Phone
- (402) 572-4019
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100330001338 | SD | Part B Supplier - Ambulance Service Supplier | 1254467186 | Practice locations: Timber Lake, SD |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 0243 | SD | Yes |
Addresses
Primary practice location
900 Main St
Timber Lake, SD 57656
Mailing address
PO Box 641880
Omaha, NE 68164-7880
Phone (402) 572-4019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9017020 | Medicaid | SD | |
| 0099213 | Other | SD | BLUE CROSS PROVIDER |
| 590014108 | Other | RR MEDICARE PROVIDER |
Other names
- TIMBER LAKE AMBULANCE SERVICE
Other providers in Timber Lake, SD
- Mobridge Regional Hospital
- Moreau-Grand Electric Cooperative, Inc
- Moreau-Grand Electric Cooperative, Inc.
- Rae Alison O'Leary
- Sheila Schweitzer
All providers in Timber Lake, SD · Land Ambulance in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.