Provider Demographics
NPI:1053819367
Name:HURLEY VOLUNTEER FIRE DEPARTMENT, INC
Entity Type:Organization
Organization Name:HURLEY VOLUNTEER FIRE DEPARTMENT, INC
Other - Org Name:HURLEY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MIKKELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:605-413-9774
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:SD
Mailing Address - Zip Code:57036-0421
Mailing Address - Country:US
Mailing Address - Phone:605-238-5888
Mailing Address - Fax:605-238-5888
Practice Address - Street 1:311 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:SD
Practice Address - Zip Code:57036
Practice Address - Country:US
Practice Address - Phone:605-238-5888
Practice Address - Fax:605-238-5888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBULANCE SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport