Leola Ambulance
Organization Active NPI Land Ambulance · Leola, SD
NPI 1194082503 · NPPES record last updated Oct 17, 2013
Key facts
- NPI
- 1194082503
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 0472 (SD)
- Legal business name
- LEOLA AMBULANCE
- Practice address
- 1208 Main St
Leola, SD 57456-0226 - Phone
- (605) 439-3314
- NPI assigned
- Apr 23, 2012
- Organization subpart
- No
Authorized official
- Name
- Mrs. Michele Smith
- Title
- Account Manager
- Phone
- (605) 793-9911
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131011000007 | SD | Part B Supplier - Ambulance Service Supplier | 0446484182 | Practice locations: Leola, SD |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 0472 | SD | Yes |
Addresses
Primary practice location
1208 Main St
Leola, SD 57456-0226
Mailing address
1208 Main St
Leola, SD 57456-0000
Phone (605) 439-3314
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0099078 | Other | SD | WELLMARK |
| 9011300 | Medicaid | SD |
Other providers in Leola, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2013. 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.