MEDICARE: PARTNER MEDICAL HOME CARE SC 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	:	1467850644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTNER MEDICAL HOME CARE SC 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	:	5710 SUNNYBROOK DR
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4249
Country	:	US
Telephone Number	:	712-252-0505
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	:	06/17/2015

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