Provider Demographics
NPI:1093900730
Name:CITY OF GETTYSBURG
Entity Type:Organization
Organization Name:CITY OF GETTYSBURG
Other - Org Name:DBA GETTYSBURG AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELIASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-765-2264
Mailing Address - Street 1:109 E COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57442-1101
Mailing Address - Country:US
Mailing Address - Phone:605-765-2264
Mailing Address - Fax:
Practice Address - Street 1:109 E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:SD
Practice Address - Zip Code:57442-1101
Practice Address - Country:US
Practice Address - Phone:605-765-2264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF GETTYSBURG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-06
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0541341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9001140Medicaid
SDS99212Medicare PIN