Provider Demographics
NPI:1740254705
Name:CITY OF MENNO
Entity type:Organization
Organization Name:CITY OF MENNO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHELSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-387-5555
Mailing Address - Street 1:236 S 5TH ST.
Mailing Address - Street 2:PO BOX 432
Mailing Address - City:MENNO
Mailing Address - State:SD
Mailing Address - Zip Code:57045-0432
Mailing Address - Country:US
Mailing Address - Phone:605-387-2427
Mailing Address - Fax:605-387-2427
Practice Address - Street 1:302 S 5TH ST.
Practice Address - Street 2:
Practice Address - City:MENNO
Practice Address - State:SD
Practice Address - Zip Code:57045-0432
Practice Address - Country:US
Practice Address - Phone:605-387-2423
Practice Address - Fax:605-387-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD 3723416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0099041OtherWELLMARK BCBS OF SD
SD9000540Medicaid
SD9000540Medicaid