Provider Demographics
NPI:1134670219
Name:MIDWEST MEDICAL TRANSPORT COMPANY, LLC-HURON, SD
Entity Type:Organization
Organization Name:MIDWEST MEDICAL TRANSPORT COMPANY, LLC-HURON, SD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-800-2934
Mailing Address - Street 1:2155 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-3148
Mailing Address - Country:US
Mailing Address - Phone:402-562-6430
Mailing Address - Fax:402-563-0937
Practice Address - Street 1:1199 DAKOTA AVE N
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-4548
Practice Address - Country:US
Practice Address - Phone:605-380-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST MEDICAL TRANSPORT COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0627341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1871991125Medicaid
NE1002649100Medicaid
NE1002649100Medicaid
SD1871991125Medicaid