Provider Demographics
NPI:1790819928
Name:CLAY UNION ELECTRIC CORP.
Entity Type:Organization
Organization Name:CLAY UNION ELECTRIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTTOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-624-2673
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-0317
Mailing Address - Country:US
Mailing Address - Phone:605-624-2673
Mailing Address - Fax:605-624-5526
Practice Address - Street 1:1410 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-1607
Practice Address - Country:US
Practice Address - Phone:605-624-2673
Practice Address - Fax:605-624-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9560090Medicaid