Provider Demographics
NPI:1265582423
Name:DALE AVIATION INC
Entity type:Organization
Organization Name:DALE AVIATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-393-0300
Mailing Address - Street 1:3900 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-8700
Mailing Address - Country:US
Mailing Address - Phone:605-393-0300
Mailing Address - Fax:605-393-0306
Practice Address - Street 1:3900 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703-8700
Practice Address - Country:US
Practice Address - Phone:605-393-0300
Practice Address - Fax:605-393-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD00293416L0300X, 3416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0099208OtherBLUE CROSS BLUE SHIELD OF SOUTH DAKOTA
SD9020080Medicaid
SD9011520Medicaid
SD9020080Medicaid