Provider Demographics
NPI:1679570295
Name:CLARK COUNTY
Entity Type:Organization
Organization Name:CLARK COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:I
Authorized Official - Last Name:TARBOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-532-5921
Mailing Address - Street 1:100 SOUTH CLOUD
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:SD
Mailing Address - Zip Code:57225
Mailing Address - Country:US
Mailing Address - Phone:605-532-5891
Mailing Address - Fax:605-532-5931
Practice Address - Street 1:100 SOUTH CLOUD
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:SD
Practice Address - Zip Code:57225
Practice Address - Country:US
Practice Address - Phone:605-532-5891
Practice Address - Fax:605-532-5931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1813416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9001192Medicaid
SD9001192Medicaid