Healthcare Provider Details

I. General information

NPI: 1508962416
Provider Name (Legal Business Name): REHABILITATION MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W. 18TH STREET
SIOUX FALLS SD
57104
US

IV. Provider business mailing address

1020 W. 18TH STREET
SIOUX FALLS SD
57104
US

V. Phone/Fax

Practice location:
  • Phone: 605-444-9702
  • Fax: 605-444-9701
Mailing address:
  • Phone: 605-444-9702
  • Fax: 605-444-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: AMY JENSEN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 605-444-9711