MEDICARE: SEMCAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site		MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7D953SE	OTHER	MN	BCBSMN PROVIDER ID

General Provider Information

NPI Number	:	1194843284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEMCAC

Provider Business Mailing Address
First Line	:	PO BOX 549
Second Line	:	204 S. ELM ST
City	:	RUSHFORD
State	:	MN
Zip	:	55971-0549
Country	:	US
Telephone Number	:	507-864-7741
Fax Number	:	507-864-2440

Provider Business Practice Location Address
First Line	:	76 W 3RD ST
Second Line	:
City	:	WINONA
State	:	MN
Zip	:	55987-3431
Country	:	US
Telephone Number	:	507-452-4307
Fax Number	:	507-457-0564

Authorized Official
Title or Position	:	HEALTH SERVICES DIRECTOR
Name	:	JOYCE PECKOVER
Credential	:	R.N., M.S.N.
Telephone Number	:	507-452-4307

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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Directions to “SEMCAC ” Practice Location

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