Provider Demographics
NPI:1336130434
Name:SPEARFISH EMERGENCY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:SPEARFISH EMERGENCY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAMBEK
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:605-642-8810
Mailing Address - Street 1:715 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2702
Mailing Address - Country:US
Mailing Address - Phone:605-642-8810
Mailing Address - Fax:605-717-0193
Practice Address - Street 1:715 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2702
Practice Address - Country:US
Practice Address - Phone:605-642-8810
Practice Address - Fax:605-717-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-30
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD00923416L0300X, 343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0099162OtherWELLMARK BCBS OF SD
SD9010990Medicaid
SD9010990Medicaid
SD590002028Medicare PIN