MEDICARE: MCCOOK COUNTY EMERGENCY MEDICAL SERVICE INC

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	146L00000X	Paramedic	0462	SD

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	:	1942233051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCOOK COUNTY EMERGENCY MEDICAL SERVICE INC

Provider Business Mailing Address
First Line	:	400 S. HILL ST.
Second Line	:
City	:	SALEM
State	:	SD
Zip	:	57058
Country	:	US
Telephone Number	:	605-425-2085
Fax Number	:	605-425-2555

Provider Business Practice Location Address
First Line	:	400 S. HILL ST.
Second Line	:
City	:	SALEM
State	:	SD
Zip	:	57058
Country	:	US
Telephone Number	:	605-425-2085
Fax Number	:	605-425-2555

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. BRADLEY JAMES STIEFVATER
Credential	:
Telephone Number	:	605-425-2085

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	10/16/2012

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