Provider Demographics
NPI:1912092305
Name:CHARLES MIX ELECTRIC ASSOCIATION INC.
Entity Type:Organization
Organization Name:CHARLES MIX ELECTRIC ASSOCIATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/CASHIER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLOREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-487-7321
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:LAKE ANDES
Mailing Address - State:SD
Mailing Address - Zip Code:57356-0010
Mailing Address - Country:US
Mailing Address - Phone:605-487-7321
Mailing Address - Fax:605-487-7868
Practice Address - Street 1:440 LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE ANDES
Practice Address - State:SD
Practice Address - Zip Code:57356-0010
Practice Address - Country:US
Practice Address - Phone:605-487-7321
Practice Address - Fax:605-487-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9560280Medicaid