Healthcare Provider Details
I. General information
NPI: 1407802432
Provider Name (Legal Business Name): NORTH CENTRAL MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2520 E OLD ORCHARD TRL
SIOUX FALLS SD
57103-4352
US
IV. Provider business mailing address
2520 E OLD ORCHARD TRL
SIOUX FALLS SD
57103-4352
US
V. Phone/Fax
- Phone: 605-338-4346
- Fax:
- Phone: 605-338-4346
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 332B00000X |
| Taxonomy | Durable Medical Equipment & Medical Supplies |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MR.
JEFF
NEIL
RYMERSON
Title or Position: PRESIDENT
Credential:
Phone: 605-338-4346