Provider Demographics
NPI:1699841981
Name:WHITE AMBULANCE SERVICE
Entity Type:Organization
Organization Name:WHITE AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-882-9911
Mailing Address - Street 1:107 N LINCOLN AVE
Mailing Address - Street 2:PO BOX 93
Mailing Address - City:WHITE
Mailing Address - State:SD
Mailing Address - Zip Code:57276
Mailing Address - Country:US
Mailing Address - Phone:605-882-9911
Mailing Address - Fax:605-882-9922
Practice Address - Street 1:107 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WHITE
Practice Address - State:SD
Practice Address - Zip Code:57276
Practice Address - Country:US
Practice Address - Phone:605-882-9911
Practice Address - Fax:605-882-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD00633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9001410Medicaid
SDS41516Medicare PIN