Crow Creek Sioux Tribe

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

0141 Issued in SD

Legal business name

CROW CREEK SIOUX TRIBE

Doing business as

Crow Creek Sioux Ambulance

Practice address

206 East Samboy
Fort Thompson, SD 57339-0409

Phone

(605) 245-2779

Fax

(605) 245-2182

NPI assigned

Feb 22, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Travis Comet Flying

Title

Director

Phone

(605) 245-2779

Specialties & licenses 1

Addresses

Other names 1

• Crow Creek Sioux Ambulance Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406160000000",
    "number": "1457486045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 409",
            "address_2": "206 EAST SAMBOY",
            "city": "FORT THOMPSON",
            "state": "SD",
            "postal_code": "573390409",
            "telephone_number": "605-245-2779",
            "fax_number": "605-245-2182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 EAST SAMBOY",
            "city": "FORT THOMPSON",
            "state": "SD",
            "postal_code": "573390409",
            "telephone_number": "605-245-2779",
            "fax_number": "605-245-2182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROW CREEK SIOUX TRIBE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2014-07-24",
        "status": "A",
        "authorized_official_last_name": "COMET FLYING",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "605-245-2779",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "SD",
            "license": "0141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crow Creek Sioux Ambulance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Lynn Bamberg, CNP
• Francesca B Benson, RDN, LN
• George R Brenneman, MD
• Heather Burull, RN
• Crow Creek Department of Public Safety
• Robert Carl Douville II, RN
• Helen Ranea Eimers, RN
• Mashaya Engel
• David Brian Foley, DDS
• Fort Thompson Ihc Clinic Pharmacy

• Land Ambulance in Fort Thompson, SD
• Providers in Fort Thompson, 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 Jul 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.