Provider Demographics
NPI:1134347115
Name:DEUEL COUNTY AMBULANCE INC
Entity type:Organization
Organization Name:DEUEL COUNTY AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-874-2191
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57226-0453
Mailing Address - Country:US
Mailing Address - Phone:605-874-8273
Mailing Address - Fax:
Practice Address - Street 1:701 3RD AVE S
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:SD
Practice Address - Zip Code:57226-2016
Practice Address - Country:US
Practice Address - Phone:605-874-8273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0231341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9001290Medicaid
SDS99149Medicare ID - Type Unspecified
SD27162Medicare UPIN
SD9001290Medicaid