Provider Demographics
NPI:1871540922
Name:COUNTY OF TRIPP
Entity type:Organization
Organization Name:COUNTY OF TRIPP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY AUDITOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-842-3727
Mailing Address - Street 1:200 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-1838
Mailing Address - Country:US
Mailing Address - Phone:605-842-3727
Mailing Address - Fax:605-842-1116
Practice Address - Street 1:100 E TRIPP AVE
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2900
Practice Address - Country:US
Practice Address - Phone:605-842-3727
Practice Address - Fax:605-842-1116
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF TRIPP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-27
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9010130Medicaid
SDS99108Medicare PIN