Organization
TIMBER LAKE AMBULANCE SERVICE INC
Active
Other names
TIMBER LAKE AMBULANCE SERVICE
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CHRIS HERMES (TREASURER)
(402) 572-4019
Entity
Organization
Contact information
Practice address
900 MAIN ST, TIMBER LAKE, SD 57656
(402) 572-4019
(402) 965-8594
Mailing address
PO BOX 641880, OMAHA, NE 68164-7880
(402) 572-4019
(402) 965-8594
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
0243
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0099213
BLUE CROSS PROVIDER
SD
01
—
590014108
RR MEDICARE PROVIDER
—
05
—
9017020
—
SD
Enumeration date
06/27/2006
Last updated
04/29/2009
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