Provider Demographics
NPI:1942233051
Name:MCCOOK COUNTY EMERGENCY MEDICAL SERVICE INC
Entity Type:Organization
Organization Name:MCCOOK COUNTY EMERGENCY MEDICAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:STIEFVATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-425-2085
Mailing Address - Street 1:400 S. HILL ST.
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:SD
Mailing Address - Zip Code:57058
Mailing Address - Country:US
Mailing Address - Phone:605-425-2085
Mailing Address - Fax:605-425-2555
Practice Address - Street 1:400 S. HILL ST.
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:SD
Practice Address - Zip Code:57058
Practice Address - Country:US
Practice Address - Phone:605-425-2085
Practice Address - Fax:605-425-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0462146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9010530Medicaid
SDS99102Medicare ID - Type Unspecified
SD0099102Medicare UPIN