Provider Demographics
NPI:1497875306
Name:BURKE AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:BURKE AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:LEIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:605-775-9055
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:SD
Mailing Address - Zip Code:57523-0061
Mailing Address - Country:US
Mailing Address - Phone:605-775-9055
Mailing Address - Fax:605-775-9055
Practice Address - Street 1:701 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:SD
Practice Address - Zip Code:57523-0061
Practice Address - Country:US
Practice Address - Phone:605-775-9055
Practice Address - Fax:605-775-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD03023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9000430Medicaid
SDS99022Medicare PIN