Provider Demographics
NPI:1689914178
Name:EASTERN PENNINGTON COUNTY AMBULANCE DISTRICT INC
Entity Type:Organization
Organization Name:EASTERN PENNINGTON COUNTY AMBULANCE DISTRICT INC
Other - Org Name:WALL AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KITTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-279-2620
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:WALL
Mailing Address - State:SD
Mailing Address - Zip Code:57790-0336
Mailing Address - Country:US
Mailing Address - Phone:605-279-2663
Mailing Address - Fax:605-279-2067
Practice Address - Street 1:210 SECOND AVENUE
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:SD
Practice Address - Zip Code:57790-0336
Practice Address - Country:US
Practice Address - Phone:605-279-2663
Practice Address - Fax:605-279-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD00263416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport