Provider Demographics
NPI:1467675967
Name:BERESFORD COMMUNITY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:BERESFORD COMMUNITY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-253-2275
Mailing Address - Street 1:50 N KNOLL DR APT 1
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-6434
Mailing Address - Country:US
Mailing Address - Phone:605-310-1924
Mailing Address - Fax:
Practice Address - Street 1:301 NORTH 10TH ST
Practice Address - Street 2:
Practice Address - City:BERESFORD
Practice Address - State:SD
Practice Address - Zip Code:57004
Practice Address - Country:US
Practice Address - Phone:605-763-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6213416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9000300Medicaid
SD9000300Medicaid