Provider Demographics
NPI:1043279896
Name:COUNTY OF MARSHALL
Entity Type:Organization
Organization Name:COUNTY OF MARSHALL
Other - Org Name:MARSHALL COUNTY AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:AUDITOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-448-2401
Mailing Address - Street 1:911 VANDER HORCK STREET
Mailing Address - Street 2:PO BOX 130
Mailing Address - City:BRITTON
Mailing Address - State:SD
Mailing Address - Zip Code:57430-0130
Mailing Address - Country:US
Mailing Address - Phone:605-448-2401
Mailing Address - Fax:605-448-2116
Practice Address - Street 1:911 VANDER HORCK STREET
Practice Address - Street 2:
Practice Address - City:BRITTON
Practice Address - State:SD
Practice Address - Zip Code:57430-0130
Practice Address - Country:US
Practice Address - Phone:605-448-2401
Practice Address - Fax:605-448-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4813416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
4998600OtherWELLMARK BCBS
SD9001480Medicaid
4998600OtherWELLMARK BCBS