MEDICARE: THORN-JETSON CORPORATION

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	251K00000X	Public Health or Welfare Agency	LPC-MH2097	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801839428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THORN-JETSON CORPORATION

Provider Business Mailing Address
First Line	:	636 SAINT. ANNE ST.
Second Line	:	SUITE 201
City	:	RAPID CITY
State	:	SD
Zip	:	57701-4694
Country	:	US
Telephone Number	:	605-716-9944
Fax Number	:	605-716-9944

Provider Business Practice Location Address
First Line	:	636 SAINT ANNE ST
Second Line	:	SUITE 201
City	:	RAPID CITY
State	:	SD
Zip	:	57701-4694
Country	:	US
Telephone Number	:	605-716-9944
Fax Number	:	605-716-9944

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELIZABETH THORN
Credential	:	MA
Telephone Number	:	605-716-9944

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	08/22/2020

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Directions to “THORN-JETSON CORPORATION ” Practice Location

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