Provider Demographics
NPI:1134129836
Name:CENTERVILLE COMMUNITY AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:CENTERVILLE COMMUNITY AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY - TREASURER/BILLING MANGR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-563-2842
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:800 MAIN
Mailing Address - City:CENTERVILLE
Mailing Address - State:SD
Mailing Address - Zip Code:57014-0181
Mailing Address - Country:US
Mailing Address - Phone:605-563-2842
Mailing Address - Fax:605-563-2804
Practice Address - Street 1:800 MAIN STREET
Practice Address - Street 2:BOX 181
Practice Address - City:CENTERVILLE
Practice Address - State:SD
Practice Address - Zip Code:57014-0181
Practice Address - Country:US
Practice Address - Phone:605-563-2842
Practice Address - Fax:605-563-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
4305151OtherBLUE CROSS BLUE SHIELD
93812OtherHEALTH PARTNERS
SD9000490Medicaid
9214848OtherDAKOTACARE
93812OtherHEALTH PARTNERS