1902972417 NPI number — HOT SPRINGS AMBULANCE SERVICE

Table of content: MRS. CRISTINA SYDNEY LORGE P.T. (NPI 1205078326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902972417 NPI number — HOT SPRINGS AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOT SPRINGS AMBULANCE SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902972417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 927
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-793-9911
Provider Business Mailing Address Fax Number:
605-793-9922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
709 S US HWY 385
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-793-9911
Provider Business Practice Location Address Fax Number:
605-793-9922
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCONT REPRESENTATIVE
Authorized Official Telephone Number:
605-793-9911

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0272 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9017060 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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