Town of Tabor

Primary specialty

AmbulanceTaxonomy code 341600000X

License

0124 Issued in SD

Legal business name

TOWN OF TABOR

Practice address

123 S Lidice St
Tabor, SD 57063-2055

Phone

(605) 463-2501

NPI assigned

Jan 26, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Evelyn Kloucek

Title

Finance Officer

Phone

(605) 463-2501

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tabor Ambulance Service Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1154477982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 146",
            "address_2": "138 N LIDICE",
            "city": "TABOR",
            "state": "SD",
            "postal_code": "570630146",
            "telephone_number": "605-463-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 S LIDICE ST",
            "city": "TABOR",
            "state": "SD",
            "postal_code": "570632055",
            "telephone_number": "605-463-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWN OF TABOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "KLOUCEK",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_title_or_position": "FINANCE OFFICER",
        "authorized_official_telephone_number": "605-463-2501"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "SD",
            "license": "0124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000590",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tabor Ambulance Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bon Homme Yankton Electric
• Rebecca Harvey, CCC-SLP
• Kristi Kocer, MA/CCC-SLP
• Cassandra Eve Santiago, CTRS
• Allurah Destiny Sutera

• All providers in Tabor, SD
• Ambulance in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.