Healthcare Provider Details

I. General information

NPI: 1942233051
Provider Name (Legal Business Name): MCCOOK COUNTY EMERGENCY MEDICAL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S. HILL ST.
SALEM SD
57058
US

IV. Provider business mailing address

400 S. HILL ST.
SALEM SD
57058
US

V. Phone/Fax

Practice location:
  • Phone: 605-425-2085
  • Fax: 605-425-2555
Mailing address:
  • Phone: 605-425-2085
  • Fax: 605-425-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number0462
License Number StateSD

VIII. Authorized Official

Name: MR. BRADLEY JAMES STIEFVATER
Title or Position: OWNER/OPERATOR
Credential:
Phone: 605-425-2085