Provider Demographics
NPI:1164470852
Name:NORTHEAST AMBULANCE SERVICE
Entity type:Organization
Organization Name:NORTHEAST AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GRIEPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-698-3797
Mailing Address - Street 1:45294 116TH ST
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-6909
Mailing Address - Country:US
Mailing Address - Phone:605-698-3797
Mailing Address - Fax:605-698-9061
Practice Address - Street 1:105 N TEDIN AVE
Practice Address - Street 2:
Practice Address - City:ROSHOLT
Practice Address - State:SD
Practice Address - Zip Code:57260-2106
Practice Address - Country:US
Practice Address - Phone:605-537-4215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD05513416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0099167OtherOTHER PROVIDER NUMBER
SD9001420Medicaid
SDS99167Medicare ID - Type UnspecifiedAMBULANCE PROVIDER NUMBER