# EDGEMONT AMBULANCE SERVICE

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

## Provider details

- **NPI number:** 1629153002
- **Authorized official:** BRENDA M LITZEL BILLING OFFICER (BILLING EAS)
- **Authorized official phone:** (605) 662-7416

## Contact information

- **Practice address:** 219 2ND STREET, EDGEMONT, SD 57735
- **Practice address phone:** (605) 662-7977
- **Practice address fax:** (605) 662-7977
- **Mailing address:** PO BOX 212, EDGEMONT, SD 57735
- **Mailing address phone:** (605) 662-7977
- **Mailing address fax:** (605) 662-7977

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 29 | SD | Yes |

## Other

- **Enumeration date:** 10/26/2006
- **Last updated:** 11/04/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 9010800 | — | SD |