Provider Demographics
NPI: | 1881685196 |
---|---|
Name: | NATIVE AMERICAN MEDICAL |
Entity Type: | Organization |
Organization Name: | NATIVE AMERICAN MEDICAL |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL SALES REP |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | LORI |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | EATON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 605-343-5948 |
Mailing Address - Street 1: | PO BOX 1360 |
Mailing Address - Street 2: | 502 MAIN ST |
Mailing Address - City: | RAPID CITY |
Mailing Address - State: | SD |
Mailing Address - Zip Code: | 57709-1360 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 605-343-5948 |
Mailing Address - Fax: | 605-341-8923 |
Practice Address - Street 1: | 502 MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | RAPID CITY |
Practice Address - State: | SD |
Practice Address - Zip Code: | 57701-2734 |
Practice Address - Country: | US |
Practice Address - Phone: | 605-343-5948 |
Practice Address - Fax: | 605-341-0923 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-11-04 |
Last Update Date: | 2008-03-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
1881685196 | Medicare UPIN |