Provider Demographics
NPI:1194843284
Name:SEMCAC
Entity Type:Organization
Organization Name:SEMCAC
Other - Org Name:SEMCAC FAMILY PLANNING CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PECKOVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:507-452-4307
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:204 S. ELM ST
Mailing Address - City:RUSHFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55971-0549
Mailing Address - Country:US
Mailing Address - Phone:507-864-7741
Mailing Address - Fax:507-864-2440
Practice Address - Street 1:76 W 3RD ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3431
Practice Address - Country:US
Practice Address - Phone:507-452-4307
Practice Address - Fax:507-457-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7D953SEOtherBCBSMN PROVIDER ID