Provider Demographics
NPI:1972640381
Name:ROSEBUD SIOUX TRIBE AMBULANCE SERVICE
Entity Type:Organization
Organization Name:ROSEBUD SIOUX TRIBE AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:BRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-747-2633
Mailing Address - Street 1:15 CIRCLE DR
Mailing Address - Street 2:PO BOX 200
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570
Mailing Address - Country:US
Mailing Address - Phone:605-747-2633
Mailing Address - Fax:
Practice Address - Street 1:15 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570
Practice Address - Country:US
Practice Address - Phone:605-747-2633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD601146L00000X, 146M00000X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
Not Answered146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Multi-Specialty
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9010690Medicaid
SD0099240OtherINSURANCE
SD9515314Medicaid
SD9515314Medicaid