1134210180 NPI number — MISSOURI VALLEY AMBULANCE SERVICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134210180 NPI number — MISSOURI VALLEY AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSOURI VALLEY 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:
1134210180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 354
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAMBERLAIN
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57325-0354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-234-4490
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 N. COURTLAND ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAMBERLAIN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-234-4490
Provider Business Practice Location Address Fax Number:
605-234-4491
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENTON
Authorized Official First Name:
KATHERYN
Authorized Official Middle Name:
Q.
Authorized Official Title or Position:
AMBULANCE DIRECTOR
Authorized Official Telephone Number:
605-234-4490

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0131 , 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: 9010752 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com