Keystone Ambulance Service Inc.

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

025 Issued in SD

Legal business name

KEYSTONE AMBULANCE SERVICE INC.

Practice address

1005 Harney Street
Box 175
Keystone, SD 57751-0175

Phone

(605) 666-5033

Fax

(605) 666-5236

NPI assigned

Jan 30, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Deana Marie Mulloy III

Title

Office Manager

Phone

(605) 666-5033

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437120359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 175",
            "address_2": "1005 HARNEY STREET",
            "city": "KEYSTONE",
            "state": "SD",
            "postal_code": "577510175",
            "telephone_number": "605-666-5033",
            "fax_number": "605-666-5236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 HARNEY STREET",
            "address_2": "BOX 175",
            "city": "KEYSTONE",
            "state": "SD",
            "postal_code": "577510175",
            "telephone_number": "605-666-5033",
            "fax_number": "605-666-5236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE AMBULANCE SERVICE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MULLOY",
        "authorized_official_first_name": "DEANA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "605-666-5033",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "SD",
            "license": "025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9002930",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Gennaro
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• Barbara L Savage, LMT

• Land Ambulance in Keystone, SD
• Providers in Keystone, SD by specialty
• Land Ambulance in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.