Provider Demographics
NPI:1942239884
Name:MOVILLE AMBULANCE AND RESCUE SQUAD
Entity Type:Organization
Organization Name:MOVILLE AMBULANCE AND RESCUE SQUAD
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:877-882-9911
Mailing Address - Street 1:45907 SD HIGHWAY 22
Mailing Address - Street 2:PO BOX 19
Mailing Address - City:CASTLEWOOD
Mailing Address - State:SD
Mailing Address - Zip Code:57223-5324
Mailing Address - Country:US
Mailing Address - Phone:877-882-9911
Mailing Address - Fax:877-882-9922
Practice Address - Street 1:5 S 1ST STREET
Practice Address - Street 2:
Practice Address - City:MOVILLE
Practice Address - State:IA
Practice Address - Zip Code:51039
Practice Address - Country:US
Practice Address - Phone:877-882-9911
Practice Address - Fax:877-882-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2970600341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA08392OtherBCBS
IA0083923Medicaid
IA08392OtherBCBS