Healthcare Provider Details

I. General information

NPI: 1912092305
Provider Name (Legal Business Name): CHARLES MIX ELECTRIC ASSOCIATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 LAKE ST
LAKE ANDES SD
57356-0010
US

IV. Provider business mailing address

PO BOX 10
LAKE ANDES SD
57356-0010
US

V. Phone/Fax

Practice location:
  • Phone: 605-487-7321
  • Fax: 605-487-7868
Mailing address:
  • Phone: 605-487-7321
  • Fax: 605-487-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SALLY J. FLOREY
Title or Position: SECRETARY/CASHIER
Credential:
Phone: 605-487-7321