Jefferson Volunteer Ambulance
Organization Active NPI Land Ambulance · Jefferson, SD
NPI 1992734818 · NPPES record last updated Oct 3, 2012
Key facts
- NPI
- 1992734818
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 623 (SD)
- Legal business name
- JEFFERSON VOLUNTEER AMBULANCE
- Practice address
- 509 Railroad St
Jefferson, SD 57038 - Phone
- (877) 882-9911
- Fax
- (877) 882-9922
- NPI assigned
- Jul 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Michele Smith
- Title
- Billing Manager
- Phone
- (877) 882-9911
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121008000576 | SD | Part B Supplier - Ambulance Service Supplier | 2062661077 | Practice locations: Jefferson, SD |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 623 | SD | Yes |
Addresses
Primary practice location
509 Railroad St
Jefferson, SD 57038
Mailing address
509 Railroad Street
Jefferson, SD 57038
Phone (877) 882-9911
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992734818 | Other | SD | WELLMARK, BCBS |
| 9001090 | Medicaid | SD |
Other providers in Jefferson, SD
All providers in Jefferson, 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 Oct 3, 2012. 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.