Healthcare Provider Details

I. General information

NPI: 1871540922
Provider Name (Legal Business Name): COUNTY OF TRIPP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E TRIPP AVE
WINNER SD
57580-2900
US

IV. Provider business mailing address

200 E 3RD ST
WINNER SD
57580-1838
US

V. Phone/Fax

Practice location:
  • Phone: 605-842-3727
  • Fax: 605-842-1116
Mailing address:
  • Phone: 605-842-3727
  • Fax: 605-842-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number602
License Number StateSD

VIII. Authorized Official

Name: MRS. JOLENE ANN HAGEN
Title or Position: DEPUTY AUDITOR
Credential:
Phone: 605-842-3727