Provider Demographics
NPI:1346327459
Name:FAULK COUNTY
Entity Type:Organization
Organization Name:FAULK COUNTY
Other - Org Name:FAULK COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:PHYLIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-598-6232
Mailing Address - Street 1:110 9TH AVE S
Mailing Address - Street 2:PO BOX 309
Mailing Address - City:FAULKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57438-0309
Mailing Address - Country:US
Mailing Address - Phone:605-598-6232
Mailing Address - Fax:605-598-6680
Practice Address - Street 1:110 9TH AVE S
Practice Address - Street 2:
Practice Address - City:FAULKTON
Practice Address - State:SD
Practice Address - Zip Code:57438-0309
Practice Address - Country:US
Practice Address - Phone:605-598-6232
Practice Address - Fax:605-598-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD02813416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0099104OtherBLUE CROSS BLUE SHIELD
SD9017090Medicaid
SDS99104Medicare PIN