Provider Demographics
NPI:1003887571
Name:ROSCOE FAMILY CARE CENTER INC
Entity Type:Organization
Organization Name:ROSCOE FAMILY CARE CENTER INC
Other - Org Name:ROSCOE FAMILY CARE CENTER,PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRESZLER
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:605-287-4900
Mailing Address - Street 1:206 W MERRILL AVE
Mailing Address - Street 2:PO BOX 260
Mailing Address - City:ROSCOE
Mailing Address - State:SD
Mailing Address - Zip Code:57471-0260
Mailing Address - Country:US
Mailing Address - Phone:605-287-4900
Mailing Address - Fax:605-287-4901
Practice Address - Street 1:206 W MERRILL AVE
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:SD
Practice Address - Zip Code:57471-0260
Practice Address - Country:US
Practice Address - Phone:605-287-4900
Practice Address - Fax:605-287-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD42223Medicare ID - Type UnspecifiedGROUP PROVIDER #