Healthcare Provider Details

I. General information

NPI: 1821161498
Provider Name (Legal Business Name): KREISERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 WEST BLVD
RAPID CITY SD
57701-2672
US

IV. Provider business mailing address

403 WEST BLVD
RAPID CITY SD
57701-2672
US

V. Phone/Fax

Practice location:
  • Phone: 605-342-2773
  • Fax: 605-342-8212
Mailing address:
  • Phone: 605-342-2773
  • Fax: 605-342-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier9167730
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: MR. PHILIP L. JOHNSON
Title or Position: VP
Credential:
Phone: 605-336-1155