Provider Demographics
NPI:1275623134
Name:CUSTER AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:CUSTER AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:HAPSIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:NUTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-673-3334
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:30 S 3RD ST
Mailing Address - City:CUSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57730
Mailing Address - Country:US
Mailing Address - Phone:605-673-3334
Mailing Address - Fax:605-673-4818
Practice Address - Street 1:30 S 3RD ST
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730
Practice Address - Country:US
Practice Address - Phone:605-673-3334
Practice Address - Fax:605-673-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0212341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9010250Medicaid
SDS99020Medicare PIN