MEDICARE: PARTNER MEDICAL HC RC LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1376941559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTNER MEDICAL HC RC LLC

Provider Business Mailing Address
First Line	:	3138 S MINNESOTA AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-5649
Country	:	US
Telephone Number	:	605-275-0083
Fax Number	:	866-590-2137

Provider Business Practice Location Address
First Line	:	403 WEST BLVD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2672
Country	:	US
Telephone Number	:	605-342-2773
Fax Number	:	866-590-2137

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRADLEY D SEVERSON
Credential	:
Telephone Number	:	605-275-0083

Provider Enumeration Date	:	12/20/2014
Last Update Date	:	06/22/2015

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