Provider Demographics
NPI:1568434066
Name:CITY OF LENNOX
Entity Type:Organization
Organization Name:CITY OF LENNOX
Other - Org Name:LENNOX AREA AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY FINANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-647-2286
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:107 S MAIN ST
Mailing Address - City:LENNOX
Mailing Address - State:SD
Mailing Address - Zip Code:57039-0228
Mailing Address - Country:US
Mailing Address - Phone:605-464-0382
Mailing Address - Fax:605-589-3672
Practice Address - Street 1:101 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:LENNOX
Practice Address - State:SD
Practice Address - Zip Code:57039-2060
Practice Address - Country:US
Practice Address - Phone:605-647-2286
Practice Address - Fax:605-647-2281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4433416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9011060Medicaid
SDS99143Medicare PIN