Healthcare Provider Details

I. General information

NPI: 1184919623
Provider Name (Legal Business Name): BON HOMME YANKTON ELECTRIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 S LIDICE AVE
TABOR SD
57063-2069
US

IV. Provider business mailing address

134 S LIDICE AVE PO BOX 158
TABOR SD
57063-2069
US

V. Phone/Fax

Practice location:
  • Phone: 605-463-2507
  • Fax: 605-463-2419
Mailing address:
  • Phone: 605-463-2507
  • Fax: 605-463-2419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State

VIII. Authorized Official

Name: MRS. KARA A ZOMER
Title or Position: BILLING CLERK
Credential:
Phone: 605-463-2507