# VIBORG AMBULANCE SERVICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114956059
- **Authorized official:** MRS. MICHELE SMITH (ACCOUNT REPRESENTATIVE)
- **Authorized official phone:** (877) 882-9911

## Contact information

- **Practice address:** 101 W SORENSON ST, VIBORG, SD 57070
- **Practice address phone:** (877) 882-9911
- **Practice address fax:** (877) 882-9922
- **Mailing address:** 101 W SORENSON ST, VIBORG, SD 57070
- **Mailing address phone:** (877) 882-9911
- **Mailing address fax:** (877) 882-9922

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 625 | SD | Yes |

## Other

- **Enumeration date:** 07/02/2006
- **Last updated:** 10/26/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 9000860 | — | SD |