# TIMBER LAKE AMBULANCE SERVICE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** TIMBER LAKE AMBULANCE SERVICE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043247679
- **Authorized official:** MISS CHRIS HERMES (TREASURER)
- **Authorized official phone:** (402) 572-4019

## Contact information

- **Practice address:** 900 MAIN ST, TIMBER LAKE, SD 57656
- **Practice address phone:** (402) 572-4019
- **Practice address fax:** (402) 965-8594
- **Mailing address:** PO BOX 641880, OMAHA, NE 68164-7880
- **Mailing address phone:** (402) 572-4019
- **Mailing address fax:** (402) 965-8594

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 0243 | SD | Yes |

## Other

- **Enumeration date:** 06/27/2006
- **Last updated:** 04/29/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0099213 | BLUE CROSS PROVIDER | SD |
| 01 | — | 590014108 | RR MEDICARE PROVIDER | — |
| 05 | — | 9017020 | — | SD |