Provider Demographics
NPI:1972530475
Name:ALCESTER AMBULANCE SERVICE
Entity Type:Organization
Organization Name:ALCESTER 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 1:106 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALCESTER
Mailing Address - State:SD
Mailing Address - Zip Code:57001
Mailing Address - Country:US
Mailing Address - Phone:605-882-9911
Mailing Address - Fax:605-882-9922
Practice Address - Street 1:106 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ALCESTER
Practice Address - State:SD
Practice Address - Zip Code:57001
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:2006-06-28
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD34-113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9000680Medicaid
SD9000680Medicaid
SDS40110Medicare PIN