Healthcare Provider Details

I. General information

NPI: 1508900697
Provider Name (Legal Business Name): COUNTY OF MINER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N. MAIN ST.
HOWARD SD
57349-0086
US

IV. Provider business mailing address

PO BOX 86
HOWARD SD
57349-0086
US

V. Phone/Fax

Practice location:
  • Phone: 605-772-4671
  • Fax: 605-772-4203
Mailing address:
  • Phone: 605-772-4671
  • Fax: 605-772-4203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3416L0300X
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9001150
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: HELEN D. SPRECHER
Title or Position: AMBULANCE BILLING MANAGER
Credential:
Phone: 605-772-4671