Provider Demographics
NPI:1497728364
Name:KARE LINES AMBULANCE, LTD
Entity Type:Organization
Organization Name:KARE LINES AMBULANCE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF AMBULANCE SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAV
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LUTJENS
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC/OWNER
Authorized Official - Phone:605-698-3300
Mailing Address - Street 1:315 5TH AVE E
Mailing Address - Street 2:PO BOX 241
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-2020
Mailing Address - Country:US
Mailing Address - Phone:605-698-3153
Mailing Address - Fax:
Practice Address - Street 1:315 5TH AVE E
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-2020
Practice Address - Country:US
Practice Address - Phone:605-698-3153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD05523416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9010460Medicaid
SD0090654OtherSD BLUE CROSS NUMBER
SDS90654Medicare ID - Type Unspecified