Provider Demographics
NPI:1821161498
Name:KREISERS INC
Entity Type:Organization
Organization Name:KREISERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-336-1155
Mailing Address - Street 1:403 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2672
Mailing Address - Country:US
Mailing Address - Phone:605-342-2773
Mailing Address - Fax:605-342-8212
Practice Address - Street 1:403 WEST BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2672
Practice Address - Country:US
Practice Address - Phone:605-342-2773
Practice Address - Fax:605-342-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9167730Medicaid
SD0538240002Medicare ID - Type Unspecified