Provider Demographics
NPI:1134210180
Name:MISSOURI VALLEY AMBULANCE SERVICE
Entity type:Organization
Organization Name:MISSOURI VALLEY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERYN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-234-4490
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:CHAMBERLAIN
Mailing Address - State:SD
Mailing Address - Zip Code:57325-0354
Mailing Address - Country:US
Mailing Address - Phone:605-234-4490
Mailing Address - Fax:
Practice Address - Street 1:306 N. COURTLAND ST.
Practice Address - Street 2:
Practice Address - City:CHAMBERLAIN
Practice Address - State:SD
Practice Address - Zip Code:57325
Practice Address - Country:US
Practice Address - Phone:605-234-4490
Practice Address - Fax:605-234-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD01313416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9010752Medicaid
SD9010752Medicaid