Healthcare Provider Details

I. General information

NPI: 1053705079
Provider Name (Legal Business Name): SEMCAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S ELM ST
RUSHFORD MN
55971-8812
US

IV. Provider business mailing address

204 S ELM ST PO BOX 549
RUSHFORD MN
55971-8812
US

V. Phone/Fax

Practice location:
  • Phone: 507-864-7741
  • Fax: 507-864-2440
Mailing address:
  • Phone: 507-864-7741
  • Fax: 507-864-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: VALARIE EVE HOWE
Title or Position: ACCOUNT III
Credential:
Phone: 507-864-7741