Healthcare Provider Details

I. General information

NPI: 1033486774
Provider Name (Legal Business Name): MOREAU-GRAND ELECTRIC COOPERATIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 NINTH STREET
TIMBER LAKE SD
57656
US

IV. Provider business mailing address

405 NINTH STREET
TIMBER LAKE SD
57656
US

V. Phone/Fax

Practice location:
  • Phone: 605-865-3511
  • Fax: 605-865-3340
Mailing address:
  • Phone: 605-865-3511
  • Fax: 605-865-3340

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: MELISSA MAHER
Title or Position: MANAGER
Credential:
Phone: 605-865-3511