Provider Demographics
NPI:1093830275
Name:HURLEY AMBULANCE
Entity Type:Organization
Organization Name:HURLEY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-238-5896
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:605-238-5896
Mailing Address - Fax:605-238-5888
Practice Address - Street 1:311 MAIN ST
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:SD
Practice Address - Zip Code:57036-0421
Practice Address - Country:US
Practice Address - Phone:605-238-5896
Practice Address - Fax:605-238-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD612013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS99052Medicare ID - Type Unspecified