MEDICARE: KISMET ELK LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326020108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KISMET ELK LLC

Provider Business Mailing Address
First Line	:	600 E LINCOLN ST
Second Line	:
City	:	ELK POINT
State	:	SD
Zip	:	57025-2284
Country	:	US
Telephone Number	:	605-356-3894
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 E LINCOLN ST
Second Line	:
City	:	ELK POINT
State	:	SD
Zip	:	57025-2284
Country	:	US
Telephone Number	:	605-356-3894
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MICHAEL L. MOORE
Credential	:
Telephone Number	:	605-642-7736

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	01/16/2019

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