Healthcare Provider Details

I. General information

NPI: 1154606119
Provider Name (Legal Business Name): PEOPLES MARKET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MAIN STREET
KADOKA SD
57543
US

IV. Provider business mailing address

905 MAIN STREET
KADOKA SD
57543
US

V. Phone/Fax

Practice location:
  • Phone: 605-837-2232
  • Fax: 605-837-2334
Mailing address:
  • Phone: 605-837-2232
  • Fax: 605-837-2334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAWNA BENDT
Title or Position: OWNER/MANAGER
Credential:
Phone: 605-837-2232