Provider Demographics
NPI:1881673705
Name:HURON AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:HURON AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-352-2600
Mailing Address - Street 1:PO BOX 3100
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3100
Mailing Address - Country:US
Mailing Address - Phone:618-529-2200
Mailing Address - Fax:605-853-2653
Practice Address - Street 1:1357 DAKOTA AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-4544
Practice Address - Country:US
Practice Address - Phone:605-352-2600
Practice Address - Fax:605-352-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0090009OtherWELLMARK
SDN0175OtherDAKOTA CARE
SD9000060Medicaid
SD590163079OtherRAIL ROAD MEDICARE
SD9000060Medicaid