Provider Demographics
NPI:1861527210
Name:PHILIP AMBULANCE SERVICE
Entity type:Organization
Organization Name:PHILIP AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARAMEDIC
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-859-2424
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:100 S LARIMER AVE
Mailing Address - City:PHILIP
Mailing Address - State:SD
Mailing Address - Zip Code:57567-0395
Mailing Address - Country:US
Mailing Address - Phone:605-859-2424
Mailing Address - Fax:
Practice Address - Street 1:100 S LARIMER AVE
Practice Address - Street 2:
Practice Address - City:PHILIP
Practice Address - State:SD
Practice Address - Zip Code:57567
Practice Address - Country:US
Practice Address - Phone:605-859-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD005507OtherINSURANCE
SD9010982Medicaid
SD9173771OtherDAKOTA CARE
SD9173771OtherDAKOTA CARE