Provider Demographics
NPI:1568538072
Name:GARRETSON COMMUNITY AMBULANCE CORPORATION
Entity Type:Organization
Organization Name:GARRETSON COMMUNITY AMBULANCE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-594-2043
Mailing Address - Street 1:638 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:GARRETSON
Mailing Address - State:SD
Mailing Address - Zip Code:57030
Mailing Address - Country:US
Mailing Address - Phone:605-594-2043
Mailing Address - Fax:605-594-2084
Practice Address - Street 1:638 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:GARRETSON
Practice Address - State:SD
Practice Address - Zip Code:57030
Practice Address - Country:US
Practice Address - Phone:605-594-2043
Practice Address - Fax:605-594-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD00123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9001002Medicaid
SDS3024Medicare PIN