# MCINTOSH VOLUNTEER FIRE DEPARTMENT AMBULANCE SERVICE, INC.

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

## Provider details

- **NPI number:** 1700096328
- **Authorized official:** SUE OR GARY BUBBERS (CAPTAIN)
- **Authorized official phone:** (605) 273-4469

## Contact information

- **Practice address:** 120 1ST AVE E, MC INTOSH, SD 57641-0174
- **Practice address phone:** (605) 273-4210
- **Mailing address:** PO BOX 174, 120 1ST AVE. EAST, MC INTOSH, SD 57641-0174

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 0201 | SD | Yes |
| 3416L0300X | Land Ambulance | 80 | ND | — |

## Other

- **Enumeration date:** 05/23/2007
- **Last updated:** 11/07/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0099232 | WELLMARK | SD |
| 05 | — | 9001170 | — | SD |