Provider Demographics
NPI:1124456603
Name:RST AMBULANCE SERVICE MINI-BUS
Entity type:Organization
Organization Name:RST AMBULANCE SERVICE MINI-BUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:EMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-474-2238
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:15 CIRCLE DRIVE
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0200
Mailing Address - Country:US
Mailing Address - Phone:605-747-2238
Mailing Address - Fax:605-747-4792
Practice Address - Street 1:15 CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-0200
Practice Address - Country:US
Practice Address - Phone:605-747-2238
Practice Address - Fax:605-747-4792
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSEBUD SIOUX TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)