Provider Demographics
NPI:1851321178
Name:HARDING COUNTY SOUTH DAKOTA
Entity Type:Organization
Organization Name:HARDING COUNTY SOUTH DAKOTA
Other - Org Name:BUFFALO OR CAMP CROOK AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:HARDING COUNTY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-375-3542
Mailing Address - Street 1:410 RAMSLAND
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:SD
Mailing Address - Zip Code:57720
Mailing Address - Country:US
Mailing Address - Phone:605-375-3542
Mailing Address - Fax:605-375-3176
Practice Address - Street 1:410 RAMSLAND
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:SD
Practice Address - Zip Code:57720
Practice Address - Country:US
Practice Address - Phone:605-375-3542
Practice Address - Fax:605-375-3176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD03513416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0099206OtherWELLMARK BCBS OF SD
SD9000050Medicaid
SDS99206Medicare ID - Type UnspecifiedAMBULANCE SERVICE