# LEOLA AMBULANCE

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

## Provider details

- **NPI number:** 1194082503
- **Authorized official:** MRS. MICHELE SMITH (ACCOUNT MANAGER)
- **Authorized official phone:** (605) 793-9911

## Contact information

- **Practice address:** 1208 MAIN ST, LEOLA, SD 57456-0226
- **Practice address phone:** (605) 439-3314
- **Mailing address:** 1208 MAIN ST, LEOLA, SD 57456-0000
- **Mailing address phone:** (605) 439-3314

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 0472 | SD | Yes |

## Other

- **Enumeration date:** 04/23/2012
- **Last updated:** 10/17/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0099078 | WELLMARK | SD |
| 05 | — | 9011300 | — | SD |