Organization
LOWER BRULE AMBULANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OTIS BRENT DOREN (PROGRAM DIRECTOR)
(605) 473-5293
Entity
Organization
Contact information
Practice address
BIA ROUTE 3, LOWER BRULE, SD 57548-0817
(605) 473-5293
(605) 473-1058
Mailing address
187 OYATE CIRCLE, LOWER BRULE, SD 57548-0187
(605) 473-5293
(605) 473-1058
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
451
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9002150
—
SD
Enumeration date
03/22/2006
Last updated
03/28/2008
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