Provider Demographics
NPI:1598884504
Name:CAMPBELL COUNTY
Entity Type:Organization
Organization Name:CAMPBELL COUNTY
Other - Org Name:CAMPBELL COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY AUDITOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAEFBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-955-3366
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:MOUND CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57646-0037
Mailing Address - Country:US
Mailing Address - Phone:605-955-3366
Mailing Address - Fax:605-955-3308
Practice Address - Street 1:111 2ND ST NE
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:SD
Practice Address - Zip Code:57646
Practice Address - Country:US
Practice Address - Phone:605-955-3366
Practice Address - Fax:605-955-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9001130Medicaid
SDS99123Medicare PIN