Organization
JEFFERSON VOLUNTEER AMBULANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELE SMITH (BILLING MANAGER)
(877) 882-9911
Entity
Organization
Contact information
Practice address
509 RAILROAD ST, JEFFERSON, SD 57038
(877) 882-9911
(877) 882-9922
Mailing address
509 RAILROAD STREET, JEFFERSON, SD 57038
(877) 882-9911
(877) 882-9922
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
623
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992734818
WELLMARK, BCBS
SD
05
—
9001090
—
SD
Enumeration date
07/02/2006
Last updated
10/03/2012
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