Provider Demographics
NPI:1114088275
Name:CONDE FIRE DEPARTMENT
Entity Type:Organization
Organization Name:CONDE FIRE DEPARTMENT
Other - Org Name:CONDE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-882-9911
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:CONDE
Mailing Address - State:SD
Mailing Address - Zip Code:57434-0122
Mailing Address - Country:US
Mailing Address - Phone:877-882-9911
Mailing Address - Fax:877-882-9922
Practice Address - Street 1:125 BROADWAY ST SW
Practice Address - Street 2:
Practice Address - City:CONDE
Practice Address - State:SD
Practice Address - Zip Code:57434
Practice Address - Country:US
Practice Address - Phone:877-882-9911
Practice Address - Fax:877-882-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD05713416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9002120Medicaid
SD0099205OtherWELLMARK, BCBS
IAS102087Medicare PIN