Provider Demographics
NPI:1144236944
Name:KADOKA AMBULANCE SERVICE
Entity Type:Organization
Organization Name:KADOKA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-837-2320
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:KADOKA
Mailing Address - State:SD
Mailing Address - Zip Code:57543-0116
Mailing Address - Country:US
Mailing Address - Phone:605-837-2320
Mailing Address - Fax:
Practice Address - Street 1:MAIN STREET
Practice Address - Street 2:
Practice Address - City:KADOKA
Practice Address - State:SD
Practice Address - Zip Code:57543-0116
Practice Address - Country:US
Practice Address - Phone:605-837-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0391341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9010070Medicaid
SD99111Medicare ID - Type Unspecified
SDS99111Medicare PIN