Provider Demographics
NPI:1093744922
Name:OELRICHS AMBULANCE SERVICE
Entity Type:Organization
Organization Name:OELRICHS AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:OSMOTHERLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-882-9911
Mailing Address - Street 1:P.O. BOX 93
Mailing Address - Street 2:
Mailing Address - City:OELRICHS
Mailing Address - State:SD
Mailing Address - Zip Code:57763-0093
Mailing Address - Country:US
Mailing Address - Phone:605-535-6855
Mailing Address - Fax:
Practice Address - Street 1:401 RAILROAD ST
Practice Address - Street 2:OELRICHS AMBULANCE SERVICE
Practice Address - City:OELRICHS
Practice Address - State:SD
Practice Address - Zip Code:57763
Practice Address - Country:US
Practice Address - Phone:605-535-6855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2743416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9011160Medicaid
SD9011160Medicaid